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Sample records for integrative medical approach

  1. A mobile agent approach for secure integrated medical information systems.

    Science.gov (United States)

    Liu, Chia-Hui; Chung, Yu-Fang; Chiang, Te-Wei; Chen, Tzer-Shyong; Wang, Sheng-De

    2012-10-01

    Different patient-related information in medical organizations is the primary reference for medical personnel diagnosing, treating, and caring patients. With the rapid development of information technology, paper-based medical records have gradually been changed to electronic forms. However, different medical organizations present individual system specifications and data-saving formats so that the medical information of the same patient cannot be exchanged, shared, and securely accessed. In order not to largely change the present medical information systems as well as not to increase abundant costs, Virtual Integrated Medical-information Systems (VIMS) is proposed to assist various hospitals in information exchange. Furthermore, with Mobile Agent, the dispersed medical information can be securely integrated. It presents confidentiality, non-repudiation, source authentication, and integrity in network transmission. Virtual Integrated Medical-information Systems (VIMS) is a virtual electronic integration system combined with Mobile Agent technology. With the features of independence, adaptability, mobility, objectives, and autonomy, Mobile Agent is applied to overcome the problems from heterogeneous systems. With the features, the over-dispersed medical records can be integrated. Moreover, Mobile Agent can ensure the instantaneity and usability of medical records from which doctors can make the most appropriate evaluation and diagnoses. It will avoid the waste of medical resources, such as repetition medication, as well as become the reference of further consultation or health check. Not only can it improve the medical care quality, but it can be provided for medical research.

  2. Posterior Approach to Kidney Dissection: An Old Surgical Approach for Integrated Medical Curricula

    Science.gov (United States)

    Daly, Frank J.; Bolender, David L.; Jain, Deepali; Uyeda, Sheryl; Hoagland, Todd M.

    2015-01-01

    Integrated medical curricular changes are altering the historical regional anatomy approach to abdominal dissection. The renal system is linked physiologically and biochemically to the cardiovascular and respiratory systems; yet, anatomists often approach the urinary system as part of the abdomen and pelvic regions. As part of an integrated…

  3. Teaching radiology to medical students: an integrated approach.

    Science.gov (United States)

    Collins, Jannette; Dotti, Susan L; Albanese, Mark A

    2002-09-01

    This study assessed medical student satisfaction with radiology lectures integrated into the 3rd-year student internal medicine clerkship, compared with faculty lectures in an independent radiology course, and investigated the effects of integrated instruction on departmental compensation from the medical school. Students' evaluations were compared, with two-way analysis of variance, for faculty who presented lectures in an integrated radiology course and faculty who presented lectures in an independent radiology course from July 1998 to June 2001. Radiology department compensation from the medical school for each course was computed per contact hour. For the integrated course (663 evaluations), the mean overall faculty rating was 1.44 (1 = excellent, 5 = poor), lower (more positive) than the mean overall rating of 1.53 for the independent course (518 evaluations) (P = .037). The interaction between type of instruction and topic was significant only for chest and musculoskeletal imaging, which were rated more positive and less positive in the integrated course, respectively (P budgeting process, awarding greater compensation per contact hour for participation in the integrated course. If only lecture hours are considered, compensation was greater for the independent course.

  4. Communication Skills in Medical Education: An Integrated Approach

    Science.gov (United States)

    Bennett, Kellie; Lyons, Zaza

    2011-01-01

    The importance of teaching communication skills in any undergraduate medical curriculum cannot be overstated. Effective doctor-patient communication is widely recognised as an essential aspect of quality patient care. A communication skills module developed for first year medical students at the University of Western Australia (UWA) is described…

  5. A community-based approach for integrating geriatrics and gerontology into undergraduate medical education.

    Science.gov (United States)

    Martinez, Iveris L; Mora, Jorge Camilo

    2012-01-01

    Medical school accreditation requirements require educational opportunities in geriatrics. Twenty-six minimum graduating competencies in geriatrics have recently been identified for medical students. The authors describe how these competencies are being integrated into a new medical curriculum through coursework and community-based experiences. This approach is intended to expose students to older adults from diverse communities and adequately prepare students to address the complex and individual needs of these patients. Initial results indicate proficiency in the minimum geriatric competencies covered. The growth and diversity of the older adult population makes it important to integrate and evaluate geriatrics education in undergraduate medical education.

  6. 78 FR 10181 - Global Quality Systems-An Integrated Approach To Improving Medical Product Safety; Public Workshop

    Science.gov (United States)

    2013-02-13

    ...] Global Quality Systems--An Integrated Approach To Improving Medical Product Safety; Public Workshop... (AFDO), is announcing a public workshop entitled ``Global Quality Systems--An Integrated Approach to Improving Medical Product Safety.'' This 2-day public workshop is intended to provide information about FDA...

  7. Designing medical technology for resilience: integrating health economics and human factors approaches.

    Science.gov (United States)

    Borsci, Simone; Uchegbu, Ijeoma; Buckle, Peter; Ni, Zhifang; Walne, Simon; Hanna, George B

    2018-01-01

    The slow adoption of innovation into healthcare calls into question the manner of evidence generation for medical technology. This paper identifies potential reasons for this including a lack of attention to human factors, poor evaluation of economic benefits, lack of understanding of the existing healthcare system and a failure to recognise the need to generate resilient products. Areas covered: Recognising a cross-disciplinary need to enhance evidence generation early in a technology's life cycle, the present paper proposes a new approach that integrates human factors and health economic evaluation as part of a wider systems approach to the design of technology. This approach (Human and Economic Resilience Design for Medical Technology or HERD MedTech) supports early stages of product development and is based on the recent experiences of the National Institute for Health Research London Diagnostic Evidence Co-operative in the UK. Expert commentary: HERD MedTech i) proposes a shift from design for usability to design for resilience, ii) aspires to reduce the need for service adaptation to technological constraints iii) ensures value of innovation at the time of product development, and iv) aims to stimulate discussion around the integration of pre- and post-market methods of assessment of medical technology.

  8. [An integrated approach including paediatric and forensic medical expertise on suspicion of child abuse].

    Science.gov (United States)

    Schouten, M C M; Karst, W A; van der Stel, H F; Teeuw, A H; van de Putte, E M

    2016-01-01

    A false accusation of child abuse has a major impact on child and family. Conversely, a missed diagnosis of child abuse may have significant and lifelong consequences for the child. For health professionals the assessment of the nature of the injury and differentiating between accidental and inflicted injury, disease manifestation or a physiological phenomenon can be challenging. For adequate determination of the cause of injury, an integrated approach including paediatric knowledge and forensic medical expertise is essential. Therefore, a national expertise centre for child abuse (LECK) was established in the Netherlands in 2014. The first results of this integrated approach are described and illustrated with three case reports. Case A, a 7-month-old boy with an accidental humerus fracture. Case B, an 8-year-old boy with a false positive suspicion of child abuse who was eventually diagnosed with Henoch-Schönlein syndrome. Case C, boy of 3 months with bruises and a metaphyseal fracture of the femur, both highly suspected of being inflicted injury.

  9. Integrated Medical Model Overview

    Science.gov (United States)

    Myers, J.; Boley, L.; Foy, M.; Goodenow, D.; Griffin, D.; Keenan, A.; Kerstman, E.; Melton, S.; McGuire, K.; Saile, L.; hide

    2015-01-01

    The Integrated Medical Model (IMM) Project represents one aspect of NASA's Human Research Program (HRP) to quantitatively assess medical risks to astronauts for existing operational missions as well as missions associated with future exploration and commercial space flight ventures. The IMM takes a probabilistic approach to assessing the likelihood and specific outcomes of one hundred medical conditions within the envelope of accepted space flight standards of care over a selectable range of mission capabilities. A specially developed Integrated Medical Evidence Database (iMED) maintains evidence-based, organizational knowledge across a variety of data sources. Since becoming operational in 2011, version 3.0 of the IMM, the supporting iMED, and the expertise of the IMM project team have contributed to a wide range of decision and informational processes for the space medical and human research community. This presentation provides an overview of the IMM conceptual architecture and range of application through examples of actual space flight community questions posed to the IMM project.

  10. Improving the Efficiency of Medical Services Systems: A New Integrated Mathematical Modeling Approach

    Directory of Open Access Journals (Sweden)

    Davood Shishebori

    2013-01-01

    Full Text Available Nowadays, the efficient design of medical service systems plays a critical role in improving the performance and efficiency of medical services provided by governments. Accordingly, health care planners in countries especially with a system based on a National Health Service (NHS try to make decisions on where to locate and how to organize medical services regarding several conditions in different residence areas, so as to improve the geographic equity of comfortable access in the delivery of medical services while accounting for efficiency and cost issues especially in crucial situations. Therefore, optimally locating of such services and also suitable allocating demands them, can help to enhance the performance and responsiveness of medical services system. In this paper, a multiobjective mixed integer nonlinear programming model is proposed to decide locations of new medical system centers, link roads that should be constructed or improved, and also urban residence centers covered by these medical service centers and link roads under investment budget constraint in order to both minimize the total transportation cost of the overall system and minimize the total failure cost (i.e., maximize the system reliability of medical service centers under unforeseen situations. Then, the proposed model is linearized by suitable techniques. Moreover, a practical case study is presented in detail to illustrate the application of the proposed mathematical model. Finally, a sensitivity analysis is done to provide an insight into the behavior of the proposed model in response to changes of key parameters of the problem.

  11. Integrating health economics modeling in the product development cycle of medical devices: A Bayesian approach

    NARCIS (Netherlands)

    Vallejo-Torres, Laura; Steuten, Lotte Maria Gertruda; Buxton, Martin J.; Girling, Alan J.; Lilford, Richard J.; Young, Terry

    2008-01-01

    Objectives: Medical device companies are under growing pressure to provide health-economic evaluations of their products. Cost-effectiveness analyses are commonly undertaken as a one-off exercise at the late stage of development of new technologies; however, the benefits of an iterative use of

  12. Designing medical technology for resilience : integrating health economics and human factors approaches

    NARCIS (Netherlands)

    Borsci, Simone; Uchegbu, Ijeoma; Buckle, Peter; Ni, Zhifang; Walne, Simon; Hanna, George B.

    2018-01-01

    Introduction: The slow adoption of innovation into healthcare calls into question the manner of evidence generation for medical technology. This paper identifies potential reasons for this including a lack of attention to human factors, poor evaluation of economic benefits, lack of understanding of

  13. A case based- shared teaching approach in undergraduate medical curriculum: the real integration in basic and clinical sciences

    Directory of Open Access Journals (Sweden)

    Soheil Peiman

    2017-05-01

    Full Text Available To present a multiple-instructor, active-learning strategy in the undergraduate medical curriculum. This educational research is a descriptive one. Shared teaching sessions, were designed for undergraduate medical students in six organ-system based courses. Sessions that involved in-class discussions of integrated clinical cases were designed implemented and moderated by at least 3 faculties (clinicians and basic scientists. The participants in this study include the basic sciences medical students of The Tehran University of Medical Sciences. Students’ reactions were assessed using an immediate post-session evaluation form on a 5-point Likert scale. Six two-hour sessions for 2 cohorts of students, 2013 and 2014 medical students during their two first years of study were implemented from April 2014 to March 2015. 17 faculty members participated in the program, 21 cases were designed, and participation average was 60 % at 6 sessions. Students were highly appreciative of this strategy. The majority of students in each course strongly agreed that this learning practice positively contributed to their learning (78% and provided better understanding and application of the material learned in an integrated classroom course (74%. They believed that the sessions affected their view about medicine (73%, and should be continued in future courses (80%. The percentage demonstrates the average of all courses. The program helped the students learn how to apply basic sciences concepts to clinical medicine. Evaluation of the program indicated that students found the sessions beneficial to their learning.

  14. An integrated model for developing research skills in an undergraduate medical curriculum: appraisal of an approach using student selected components.

    Science.gov (United States)

    Riley, Simon C; Morton, Jeremy; Ray, David C; Swann, David G; Davidson, Donald J

    2013-09-01

    Student selected components (SSCs), at that time termed special study modules, were arguably the most innovative element in Tomorrow's Doctors (1993), the document from the General Medical Council that initiated the modernization of medical curricula in the UK. SSCs were proposed to make up one-third of the medical curriculum and provide students with choice, whilst allowing individual schools autonomy in how SSCs were utilized. In response, at the University of Edinburgh the undergraduate medical curriculum provides an integrated and sequential development and assessment of research skill learning outcomes, for all students in the SSC programme. The curriculum contains SSCs which provide choice to students in all 5 years. There are four substantial timetabled SSCs where students develop research skills in a topic and speciality of their choice. These SSCs are fully integrated and mapped with core learning outcomes and assessment, particularly with the 'Evidence-Based Medicine and Research' programme theme. These research skills are developed incrementally and applied fully in a research project in the fourth year. One-third of students also perform an optional intercalated one-year honours programme between years 2 and 3, usually across a wide range of honours schools at the biomedical science interface. Student feedback is insightful and demonstrates perceived attainment of research competencies. The establishment of these competencies is discussed in the context of enabling junior graduate doctors to be effective and confident at utilizing their research skills to effectively practice evidence-based medicine. This includes examining their own practice through clinical audit, developing an insight into the complexity of the evidence base and uncertainty, and also gaining a view into a career as a clinical academic.

  15. Integration a functional approach

    CERN Document Server

    Bichteler, Klaus

    1998-01-01

    This book covers Lebesgue integration and its generalizations from Daniell's point of view, modified by the use of seminorms. Integrating functions rather than measuring sets is posited as the main purpose of measure theory. From this point of view Lebesgue's integral can be had as a rather straightforward, even simplistic, extension of Riemann's integral; and its aims, definitions, and procedures can be motivated at an elementary level. The notion of measurability, for example, is suggested by Littlewood's observations rather than being conveyed authoritatively through definitions of (sigma)-algebras and good-cut-conditions, the latter of which are hard to justify and thus appear mysterious, even nettlesome, to the beginner. The approach taken provides the additional benefit of cutting the labor in half. The use of seminorms, ubiquitous in modern analysis, speeds things up even further. The book is intended for the reader who has some experience with proofs, a beginning graduate student for example. It might...

  16. APPROACHES TO PUBLIC INTEGRITY

    Directory of Open Access Journals (Sweden)

    Simona-Roxana ULMAN

    2015-08-01

    Full Text Available Both concepts, integrity and public integrity, are always asked qualities in the social and economic environment, but they are never well defined. In this context, finding precise definitions and offering an ample explanation of the concepts are desired and useful for both economic theoretical and practical levels and become the aim of the present paper. Without a good understanding of a concept, no one is capable to attain it. In this context, it is impossible to ask for a public sector of integrity if both public actors and the citizens do not know what it really means. Therefore, the public actors first have to understand what integrity really supposes, and, then, to be capable to respect its principles. Taking into consideration the effects of public integrity or, on its opposite, of the divergence from it, especially represented by the phenomenon of corruption, on the economy at the macro, but also, on the micro level, public integrity in itself becomes a real economic problem that is aimed to be extensively analyzed through our interdisciplinary approach.

  17. Integrating Public Health and Health Promotion Practice in the Medical Curriculum: A Self-Directed Team-Based Project Approach

    Directory of Open Access Journals (Sweden)

    Geraldine Kershaw

    2017-08-01

    Full Text Available Preparing health professionals in health promotion (HP and disease prevention is essential for improvement of population health, community HP, and better health care for individuals. The aim of this article is to describe an HP project in the form of a major self-directed project-based learning task integrated within the curriculum in the second year of the medical degree program at United Arab Emirates University. The project introduces students to public health and HP practice and develops students’ literature searching, writing, presentation skills, and team work. Students learn the principles underlying behavioral change, and the design of HP programs and materials, through a lecture format. Small groups of students each choose a specific health topic for their project. Over 11 weeks, students obtain information about their topic from appropriate sources (library, PubMed, Google Scholar, credible health sources such as World Health Organization. Using the principles learned in the lectures, they develop appropriate materials for their target audience: for example, posters, a pamphlet, social media content, or a video or radio message. Students seek advice from specialist faculty as needed. In week 12, each team presents their project background, rationale, and materials to their colleagues in a seminar format open to all faculty. They then submit the materials they developed for assessment. Group marks are assigned for presentations and materials. Key concepts are assessed by multiple choice questions in comprehensive course examinations. By participation in the HP project, many students develop a solid background in prevention. The information retrieval, writing, and presentation skills, as well as experience of team work, are valuable both for the remaining years of their training and their future careers.

  18. Integrating Public Health and Health Promotion Practice in the Medical Curriculum: A Self-Directed Team-Based Project Approach.

    Science.gov (United States)

    Kershaw, Geraldine; Grivna, Michal; Elbarazi, Iffat; AliHassan, Souheila; Aziz, Faisal; Al Dhaheri, Aysha Ibrahim

    2017-01-01

    Preparing health professionals in health promotion (HP) and disease prevention is essential for improvement of population health, community HP, and better health care for individuals. The aim of this article is to describe an HP project in the form of a major self-directed project-based learning task integrated within the curriculum in the second year of the medical degree program at United Arab Emirates University. The project introduces students to public health and HP practice and develops students' literature searching, writing, presentation skills, and team work. Students learn the principles underlying behavioral change, and the design of HP programs and materials, through a lecture format. Small groups of students each choose a specific health topic for their project. Over 11 weeks, students obtain information about their topic from appropriate sources (library, PubMed, Google Scholar, credible health sources such as World Health Organization). Using the principles learned in the lectures, they develop appropriate materials for their target audience: for example, posters, a pamphlet, social media content, or a video or radio message. Students seek advice from specialist faculty as needed. In week 12, each team presents their project background, rationale, and materials to their colleagues in a seminar format open to all faculty. They then submit the materials they developed for assessment. Group marks are assigned for presentations and materials. Key concepts are assessed by multiple choice questions in comprehensive course examinations. By participation in the HP project, many students develop a solid background in prevention. The information retrieval, writing, and presentation skills, as well as experience of team work, are valuable both for the remaining years of their training and their future careers.

  19. Thinking about thinking and emotion: the metacognitive approach to the medical humanities that integrates the humanities with the basic and clinical sciences.

    Science.gov (United States)

    Eichbaum, Quentin G

    2014-01-01

    Medical knowledge in recent decades has grown prodigiously and has outstripped the capacity of the human brain to absorb and understand it all. This burgeoning of knowledge has created a dilemma for medical educators. We can no longer expect students to continue memorizing this large body of increasingly complex knowledge. Instead, our efforts should be redirected at developing in students a competency as flexible thinkers and agile learners so they can adeptly deal with new knowledge, complexity, and uncertainty in a rapidly changing world. Such a competency would entail not only cognitive but also emotional skills essential for the holistic development of their professional identity. This article will argue that metacognition--“thinking about thinking (and emotion)”--offers the most viable path toward developing this competency. The overwhelming volume of medical knowledge has driven some medical schools to reduce the time allocated in their curricula to the “soft-option” humanities as they tend to consider them an expendable “luxury.” Vanderbilt University School of Medicine, Nashville, TN, has moved away from the traditional conception of the medical humanities as “the arts,” composed of art, music, and literature, toward an approach that integrates the humanities with the basic and clinical sciences, based on metacognition. This metacognitive approach to the humanities, described in this article, has three goals: 1) to develop students as flexible thinkers and agile learners and to provide them with essential cognitive and emotional skills for navigating medical complexity and uncertainty; 2) to elicit in students empathy and tolerance by making them aware of the immense diversity in human cognition (and emotion); and 3) to integrate the humanities with the basic and clinical sciences. Through this metacognitive approach, students come to understand their patterns of cognition and emotions, and in the group setting, they learn to mindfully

  20. Integrating global health with medical education.

    Science.gov (United States)

    Aulakh, Alex; Tweed, Sam; Moore, Jolene; Graham, Wendy

    2017-04-01

    Globalisation has implications for the next generation of doctors, and thus for medical education. Increasingly, global health is being taught in medical schools, although its incorporation into an already full curriculum presents challenges. Global health was introduced into the MBChB curriculum at the University of Aberdeen through a student-selected component (SSC) as part of an existing medical humanities block. The Global Health and Humanities (GHH) module was first delivered in the autumn of 2013 and will shortly enter its third year. This student-led study used quantitative and qualitative methods to assess the module's appropriateness and effectiveness for strengthening learning on global health, consisting of online surveys for course participants and semi-structured interviews with faculty members. Integrating global health into the undergraduate medical curriculum by way of an SSC was regarded by teaching staff as an effective and realistic approach. A recognised strength of delivering global health as part of the medical humanities block was the opportunity to expose students to the social determinants of health through interdisciplinary teaching. Participating students all agreed that the learning approach strengthened both their knowledge of global health and a range of generic skills. SSCs are, by definition, self-selecting, and will have a tendency to attract students already with an interest in a topic - here global health. A wide range of learning opportunities is needed to integrate global health throughout medical curricula, and to reach all students. © 2016 John Wiley & Sons Ltd.

  1. Integrative health coaching: a behavior skills approach that improves HbA1c and pharmacy claims-derived medication adherence.

    Science.gov (United States)

    Wolever, Ruth Q; Dreusicke, Mark H

    2016-01-01

    Medication adherence requires underlying behavior skills and a supporting mindset that may not be addressed with education or reminders. Founded in the study of internal motivation and health psychology, integrative health coaching (IHC) helps patients gain insight into their behaviors and make long-term, sustainable lifestyle changes. The purpose of the study is to determine whether IHC improves oral medication adherence, glycated hemoglobin (HbA1c), and psychosocial measures, and to assess whether adherence changes are sustained after the intervention. Using a prospective observational design, participants (n=56) received 14 coaching calls by telephone over 6 months. Medication possession ratio (MPR) was calculated for time intervals before, during, and after the intervention. HbA1c and patient-reported psychosocial outcomes were obtained to test interactions with MPR. Medication adherence (MPR) increased from 0.74±0.197 to 0.85±0.155 during coaching, and was sustained at 0.82±0.175 during a 6-month period after the study. Better adherence correlated with a greater decrease in HbA1c. HbA1c decreased from 8.0±1.92% to 7.7±1.70% over the 6-month intervention. All psychosocial measures showed significant improvement. In addition to discussing medication adherence strategies with their coach, patients discussed nutrition and exercise (86.9% of calls), stress management (39.8%), and social support and relationships (15.4%). IHC targets internal motivation and supports behavior change by facilitating patients' insight into their own behaviors, and it uses this insight to foster self-efficacy. This approach may yield sustainable results for medication adherence and warrants further exploration for health-related behavior change.

  2. Toward an Integrated Psychological Approach - Phase II

    International Development Research Centre (IDRC) Digital Library (Canada)

    Trauma, Development and Peacebuilding : Toward an Integrated Psychological Approach - Phase II. Over the past decade, the peace, conflict and development community has begun to question the value of medicalized approaches such as post-traumatic stress disorder (PTSD) in dealing with aftermath of political violence ...

  3. Systems innovation model: an integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center.

    Science.gov (United States)

    Eisenberg, Dan; Lohnberg, Jessica A; Kubat, Eric P; Bates, Cheryl C; Greenberg, Lauren M; Frayne, Susan M

    2017-04-01

    Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers. To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey. Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m 2 (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts. Published by

  4. Integrative medicine approach to chronic pain.

    Science.gov (United States)

    Teets, Raymond Y; Dahmer, Stephen; Scott, Emilie

    2010-06-01

    Chronic pain can be a frustrating condition for patient and clinician. The integrative medicine approach to pain can offer hope, adding safe complementary and alternative medical (CAM) therapies to mitigate pain and suffering. Such CAM therapies include nutrition, supplements and herbs, manual medicine, acupuncture, yoga, and mind-body approaches. The evidence is heterogeneous regarding these approaches, but some evidence suggests efficacy and confirms safety. The integrative medicine approach can be beneficial in a patient with chronic pain. Copyright 2010 Elsevier Inc. All rights reserved.

  5. Psychological maintenance as an integrated approach to prevention and correction of professional burning out of the medical staff

    Directory of Open Access Journals (Sweden)

    V. S. Kucher

    2014-01-01

    Full Text Available The syndrome of professional burning out is a complex of symptoms and signs evidenced in various negative psychic conditions at individual, interpersonal and organizational levels. It is formed owing to a long mismatch between the requirements of the professional environment and the resources of the expert. Analysis of the preventive and correctional programs as a psychological assistance showed insufficiency of such approach. Creation of preventive and correctional programs within psychological maintenance from the position of involution of professional resources, taking into account the theoretical - methodological basis (the concept, the purposes, tasks, system approach, criteria of efficiency and the subjective-personal resources of counteraction directed at activization to burning out at all stages of professional development is progressive.

  6. An Interdisciplinary Approach Between Medical Informatics and Social Sciences to Transdisciplinary Requirements Engineering for an Integrated Care Setting.

    Science.gov (United States)

    Vielhauer, Jan; Böckmann, Britta

    2017-01-01

    Requirements engineering of software products for elderly people faces some special challenges to ensure a maximum of user acceptance. Within the scope of a research project, a web-based platform and a mobile app are approached to enable people to live in their own home as long as possible. This paper is about a developed method of interdisciplinary requirements engineering by a team of social scientists in cooperation with computer scientists.

  7. Back to the basic sciences: an innovative approach to teaching senior medical students how best to integrate basic science and clinical medicine.

    Science.gov (United States)

    Spencer, Abby L; Brosenitsch, Teresa; Levine, Arthur S; Kanter, Steven L

    2008-07-01

    Abraham Flexner persuaded the medical establishment of his time that teaching the sciences, from basic to clinical, should be a critical component of the medical student curriculum, thus giving rise to the "preclinical curriculum." However, students' retention of basic science material after the preclinical years is generally poor. The authors believe that revisiting the basic sciences in the fourth year can enhance understanding of clinical medicine and further students' understanding of how the two fields integrate. With this in mind, a return to the basic sciences during the fourth year of medical school may be highly beneficial. The purpose of this article is to (1) discuss efforts to integrate basic science into the clinical years of medical student education throughout the United States and Canada, and (2) describe the highly developed fourth-year basic science integration program at the University of Pittsburgh School of Medicine. In their critical review of medical school curricula of 126 U.S. and 17 Canadian medical schools, the authors found that only 19% of U.S. medical schools and 24% of Canadian medical schools require basic science courses or experiences during the clinical years, a minor increase compared with 1985. Curricular methods ranged from simple lectures to integrated case studies with hands-on laboratory experience. The authors hope to advance the national discussion about the need to more fully integrate basic science teaching throughout all four years of the medical student curriculum by placing a curricular innovation in the context of similar efforts by other U.S. and Canadian medical schools.

  8. Integrated Medical Model – Chest Injury Model

    Data.gov (United States)

    National Aeronautics and Space Administration — The Exploration Medical Capability (ExMC) Element of NASA's Human Research Program (HRP) developed the Integrated Medical Model (IMM) to forecast the resources...

  9. Integrative approaches: promoting socioecological resilience

    Science.gov (United States)

    J.W. Long; Carl Skinner; M. North; C.T. Hunsaker; L. Quinn-Davidson

    2014-01-01

    This chapter begins by discussing current challenges for ecosystem management that emerged from multiple chapters of the full synthesis. It then considers integrative approaches to promote resilience, including general strategies that recognize the integrated nature of socioecological systems, the importance of promoting disturbance regimes upon which these systems...

  10. Thyroiditis: an integrated approach.

    Science.gov (United States)

    Sweeney, Lori B; Stewart, Christopher; Gaitonde, David Y

    2014-09-15

    Thyroiditis is a general term that encompasses several clinical disorders characterized by inflammation of the thyroid gland. The most common is Hashimoto thyroiditis; patients typically present with a nontender goiter, hypothyroidism, and an elevated thyroid peroxidase antibody level. Treatment with levothyroxine ameliorates the hypothyroidism and may reduce goiter size. Postpartum thyroiditis is transient or persistent thyroid dysfunction that occurs within one year of childbirth, miscarriage, or medical abortion. Release of preformed thyroid hormone into the bloodstream may result in hyperthyroidism. This may be followed by transient or permanent hypothyroidism as a result of depletion of thyroid hormone stores and destruction of thyroid hormone-producing cells. Patients should be monitored for changes in thyroid function. Beta blockers can treat symptoms in the initial hyperthyroid phase; in the subsequent hypothyroid phase, levothyroxine should be considered in women with a serum thyroid-stimulating hormone level greater than 10 mIU per L, or in women with a thyroid-stimulating hormone level of 4 to 10 mIU per L who are symptomatic or desire fertility. Subacute thyroiditis is a transient thyrotoxic state characterized by anterior neck pain, suppressed thyroid-stimulating hormone, and low radioactive iodine uptake on thyroid scanning. Many cases of subacute thyroiditis follow an upper respiratory viral illness, which is thought to trigger an inflammatory destruction of thyroid follicles. In most cases, the thyroid gland spontaneously resumes normal thyroid hormone production after several months. Treatment with high-dose acetylsalicylic acid or nonsteroidal anti-inflammatory drugs is directed toward relief of thyroid pain.

  11. A secure integrated medical information system.

    Science.gov (United States)

    Hsiao, Tsung-Chih; Wu, Zhen-Yu; Chung, Yu-Fang; Chen, Tzer-Shyong; Horng, Gwo-Boa

    2012-10-01

    The rapid rise and development of the internet has made digitization of our everyday life common. E-medicine, including electronic prescription records, electronic prescriptions, diagnosis information systems, and others are now being regarded as future trends. As development on the structure and format of electronic patient records and prescriptions matures, the implementation of a comprehensive medical information system is imperative, one which is constructed from integrating the various electronic information systems that is being developed. It is important to allow the implementation of such a system applicable to the present medical environment, which facilitates the integration of electronic patient record from all levels of medical centers and clinics, secures the transmission of these integrated patient records between them, enables the combined use of electronic prescriptions with patients' medications, and permits anonymous or confidential transmission of patients' private data. To put the ideas into practice, in this study, we would like to propose an Integrated Medical Information System.

  12. [Medical approach to "the Quixote"].

    Science.gov (United States)

    Sánchez Granjel, Luis

    2005-01-01

    The study of the madness that turned the gentleman Alonso Quijano into the knight don Quixote, gives us no acceptable explanation about the reason of that mental disorder; this madness has already had a array of medical approaches. In order to understand it, there exist two possible factors: the repression of a sexual necessity which his nature imposed on himself, and the behaviour he was obliged to have because of his condition of gentleman; this study will try to explain and value these factors, taking also into account the information provided by the novel.

  13. An Integrated Approach to Biology

    Indian Academy of Sciences (India)

    An Integrated Approach to Biology. Aniket Bhattacharya. Keywords. Zoology, genomics, schistoso- miasis, schistosome genomics, praziquantel, origin of clothing. Zoology, being a basic bioscience, is essential for a better understanding of applied biological disciplines. A sound back- ground in zoology can often be the key ...

  14. An Integrated Approach to Biology

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 16; Issue 8. An Integrated Approach to Biology. Aniket Bhattacharya. General Article Volume 16 Issue 8 August 2011 pp 742-753 ... Keywords. Zoology; genomics; schistosomiasis; schistosome genomics; praziquantel; origin of clothing.

  15. Integrated Medical Curriculum: Advantages and Disadvantages

    OpenAIRE

    Quintero, Gustavo A.; Vergel, John; Arredondo, Martha; Ariza, María-Cristina; Gómez, Paula; Pinzon-Barrios, Ana-Maria

    2016-01-01

    Most curricula for medical education have been integrated horizontally and vertically–-vertically between basic and clinical sciences. The Flexnerian curriculum has disappeared to permit integration between basic sciences and clinical sciences, which are taught throughout the curriculum. We have proposed a different form of integration where the horizontal axis represents the defined learning outcomes and the vertical axis represents the teaching of the sciences throughout the courses. We bel...

  16. Ares I Integrated Test Approach

    Science.gov (United States)

    Taylor, Jim

    2008-01-01

    This slide presentation reviews the testing approach that NASA is developing for the Ares I launch vehicle. NASA is planning a complete series of development, qualification and verification tests. These include: (1) Upper stage engine sea-level and altitude testing (2) First stage development and qualification motors (3) Upper stage structural and thermal development and qualification test articles (4) Main Propulsion Test Article (MPTA) (5) Upper stage green run testing (6) Integrated Vehicle Ground Vibration Testing (IVGVT) and (7) Aerodynamic characterization testing.

  17. Integrative medical education: educational strategies and preliminary evaluation of the Integrated Curriculum for Anthroposophic Medicine (ICURAM).

    Science.gov (United States)

    Scheffer, Christian; Tauschel, Diethard; Neumann, Melanie; Lutz, Gabriele; Cysarz, Dirk; Heusser, Peter; Edelhäuser, Friedrich

    2012-12-01

    the development and preliminary evaluation of a new medical program aimed at educating students in patient-centered integrative care and developing appropriate educational strategies. The Integrated Curriculum for Anthroposophic Medicine (ICURAM) was developed with modules on anthroposophic medicine integrated into the full 6 years of the regular medical curriculum. The educational strategy is the ESPRI(2)T approach, combining Exploratory learning, Supported participation, Patient-based learning, Reflective practice, Integrated learning, an Integrative approach and Team-based learning. The student participation, assessed based on the number of credit points earned per year (ctp/year) through the ICURAM (1 ctp=30 h workload), served as a preliminary indicator of student interest. Of the 412 55%medical students participated in the program: 16% full participation (≥ 4 ctp/year), 18% partial participation (1-3.99 ctp/year) and 22% occasional participation (0.25-0.99 ctp/year). The amount of additional workload taken on by students was between 7.8h/year for occasional participants, 33 h/year for partial participants and 84 h/year for full participants. More than half of medical students were willing to invest a significant amount of additional time in the optional program. An integrative medical curriculum with a student-centered educational strategy seems to be of interest to most medical students. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. The Integrated Medical Model: A Risk Assessment and Decision Support Tool for Space Flight Medical Systems

    Science.gov (United States)

    Kerstman, Eric; Minard, Charles; Saile, Lynn; deCarvalho, Mary Freire; Myers, Jerry; Walton, Marlei; Butler, Douglas; Iyengar, Sriram; Johnson-Throop, Kathy; Baumann, David

    2009-01-01

    The Integrated Medical Model (IMM) is a decision support tool that is useful to mission planners and medical system designers in assessing risks and designing medical systems for space flight missions. The IMM provides an evidence based approach for optimizing medical resources and minimizing risks within space flight operational constraints. The mathematical relationships among mission and crew profiles, medical condition incidence data, in-flight medical resources, potential crew functional impairments, and clinical end-states are established to determine probable mission outcomes. Stochastic computational methods are used to forecast probability distributions of crew health and medical resource utilization, as well as estimates of medical evacuation and loss of crew life. The IMM has been used in support of the International Space Station (ISS) medical kit redesign, the medical component of the ISS Probabilistic Risk Assessment, and the development of the Constellation Medical Conditions List. The IMM also will be used to refine medical requirements for the Constellation program. The IMM outputs for ISS and Constellation design reference missions will be presented to demonstrate the potential of the IMM in assessing risks, planning missions, and designing medical systems. The implementation of the IMM verification and validation plan will be reviewed. Additional planned capabilities of the IMM, including optimization techniques and the inclusion of a mission timeline, will be discussed. Given the space flight constraints of mass, volume, and crew medical training, the IMM is a valuable risk assessment and decision support tool for medical system design and mission planning.

  19. Integrated Approach to Competitive Advantage

    Directory of Open Access Journals (Sweden)

    Edita Ragelskaja

    2011-07-01

    Full Text Available Environmental changes and globalization of markets make an impact on intense competition in almost all business sectors. Evolutionary changes influence companies to learn, adequately react, adapt to environmental changes and to change themselves. Such a situation has revealed the problems of competitive advan­tage of industry companies. Therefore the focus to the factors impacting competitive advantage is seen as timely and relevant. The authors of the paper analyze approaches to competitive advantage and the factors impacting competitive advantage. The integrated model of competitive advantage is proposed in the paper.Article in Lithuanian

  20. 78 FR 27343 - Medical Examiner's Certification Integration

    Science.gov (United States)

    2013-05-10

    ... DEPARTMENT OF TRANSPORTATION Federal Motor Carrier Safety Administration 49 CFR Parts 383, 384 and 391 [Docket No. FMCSA-2012-0178] RIN 2126-AB40 Medical Examiner's Certification Integration AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT. ACTION: Notice of proposed rulemaking. SUMMARY...

  1. Emphasizing humanities in medical education: Promoting the integration of medical scientific spirit and medical humanistic spirit.

    Science.gov (United States)

    Song, Peipei; Tang, Wei

    2017-05-23

    In the era of the biological-psychological-social medicine model, an ideal of modern medicine is to enhance the humanities in medical education, to foster medical talents with humanistic spirit, and to promote the integration of scientific spirit and humanistic spirit in medicine. Throughout the United States (US), United Kingdom (UK), other Western countries, and some Asian countries like Japan, many medical universities have already integrated the learning of medical humanities in their curricula and recognized their value. While in China, although medical education reform over the past decade has emphasized the topic of medical humanities to increase the professionalism of future physicians, the integration of medical humanity courses in medical universities has lagged behind the pace in Western countries. In addition, current courses in medical humanities were arbitrarily established due to a lack of organizational independence. For various reasons like a shortage of instructors, medical universities have failed to pay sufficient attention to medical humanities education given the urgent needs of society. The medical problems in contemporary Chinese society are not solely the purview of biomedical technology; what matters more is enhancing the humanities in medical education and fostering medical talents with humanistic spirit. Emphasizing the humanities in medical education and promoting the integration of medical scientific spirit and medical humanistic spirit have become one of the most pressing issues China must address. Greater attention should be paid to reasonable integration of humanities into the medical curriculum, creation of medical courses related to humanities and optimization of the curriculum, and actively allocating abundant teaching resources and exploring better methods of instruction.

  2. Integrated Medical Curriculum: Advantages and Disadvantages

    Directory of Open Access Journals (Sweden)

    Gustavo A. Quintero

    2016-01-01

    Full Text Available Most curricula for medical education have been integrated horizontally and vertically–-vertically between basic and clinical sciences. The Flexnerian curriculum has disappeared to permit integration between basic sciences and clinical sciences, which are taught throughout the curriculum. We have proposed a different form of integration where the horizontal axis represents the defined learning outcomes and the vertical axis represents the teaching of the sciences throughout the courses. We believe that a mere integration of basic and clinical sciences is not enough because it is necessary to emphasize the importance of humanism as well as health population sciences in medicine. It is necessary to integrate basic and clinical sciences, humanism, and health population in the vertical axis, not only in the early years but also throughout the curriculum, presupposing the use of active teaching methods based on problems or cases in small groups.

  3. Integrated Medical Curriculum: Advantages and Disadvantages.

    Science.gov (United States)

    Quintero, Gustavo A; Vergel, John; Arredondo, Martha; Ariza, María-Cristina; Gómez, Paula; Pinzon-Barrios, Ana-Maria

    2016-01-01

    Most curricula for medical education have been integrated horizontally and vertically--vertically between basic and clinical sciences. The Flexnerian curriculum has disappeared to permit integration between basic sciences and clinical sciences, which are taught throughout the curriculum. We have proposed a different form of integration where the horizontal axis represents the defined learning outcomes and the vertical axis represents the teaching of the sciences throughout the courses. We believe that a mere integration of basic and clinical sciences is not enough because it is necessary to emphasize the importance of humanism as well as health population sciences in medicine. It is necessary to integrate basic and clinical sciences, humanism, and health population in the vertical axis, not only in the early years but also throughout the curriculum, presupposing the use of active teaching methods based on problems or cases in small groups.

  4. [WEB-based medical data mining integration].

    Science.gov (United States)

    Yao, Gang; Zhang, Xiaoxiang; Wang, Huoming

    2014-06-01

    An integration of medical data management system based on WEB and data mining tool is reportedly in this paper. In the application process of this system, web-based medical data mining user sends requests to the server by using client browser with http protocol, the commands are then received by the server and the server calls the data mining tools remote object for data processing, and the results are sent back to the customer browser through the http protocol and presented to the user. In order to prove the feasibility of the proposed solution, the test is done under the NET platform by using SAS and SPSS, and the detail steps are given. By the practical test, it was proved that the web-based data mining tool integration solutions proposed in this paper would have its broad prospects for development, which would open up a new route to the development of medical data mining.

  5. A Database Approach to Computer Integrated Manufacturing

    Science.gov (United States)

    1988-06-01

    BACKGROUND .......................................................................................... 28 B. WHAT IS COMPUTER INTEGRATED MANUFACTURING...CIM is a modular approach to integration. B. WHAT IS COMPUTER INTEGRATED MANUFACTURING? There is a wide diversity of definitions of CIM in the

  6. DOE systems approach and integration

    International Nuclear Information System (INIS)

    Logan, J.A.

    1987-01-01

    Six sites are now disposing of most of DOE's currently generated waste. These are: Hanford, Idaho National Engineering Laboratory, Los Alamos National Laboratory, the Nevada Test Site, Oak Ridge, and Savannah River. Within DOE, experience with disposal of solid LLW has been that arid site disposal facilities (first four) appear to have performed well, while humid site disposal facilities (last two) have experienced some waste migration. DOE's intent, of course, is to operate all its waste disposal facilities so that public health and safety are not adversely affected. To ensure that this continues to be the case, activities are underway to increase use of waste form stabilization and engineered barriers where appropriate. For the sake of overall economy, these measures are to be applied as and where needed, through use of the systems approach. In this paper the author discusses two topics: the system approach, which DOE has decided to use for resolving waste disposal problems in the management of DOE's low-level wastes; and DOE's intended integration of activities underway at the waste management systems throughout DOE facilities. 2 figures

  7. Marital Counseling: An Integrated Brief Therapy Approach.

    Science.gov (United States)

    Magnuson, Sandy; Norem, Ken

    1998-01-01

    Addresses advantages of, and potential pitfalls in, integrated approaches to marital counseling. Presents a sequential approach in which various approaches to marital counseling are integrated without jeopardizing internal consistency and uniformity in treatment. Offers precounseling considerations and procedures for a five-session series.…

  8. A framework for integration of heterogeneous medical imaging networks.

    Science.gov (United States)

    Viana-Ferreira, Carlos; Ribeiro, Luís S; Costa, Carlos

    2014-01-01

    Medical imaging is increasing its importance in matters of medical diagnosis and in treatment support. Much is due to computers that have revolutionized medical imaging not only in acquisition process but also in the way it is visualized, stored, exchanged and managed. Picture Archiving and Communication Systems (PACS) is an example of how medical imaging takes advantage of computers. To solve problems of interoperability of PACS and medical imaging equipment, the Digital Imaging and Communications in Medicine (DICOM) standard was defined and widely implemented in current solutions. More recently, the need to exchange medical data between distinct institutions resulted in Integrating the Healthcare Enterprise (IHE) initiative that contains a content profile especially conceived for medical imaging exchange: Cross Enterprise Document Sharing for imaging (XDS-i). Moreover, due to application requirements, many solutions developed private networks to support their services. For instance, some applications support enhanced query and retrieve over DICOM objects metadata. This paper proposes anintegration framework to medical imaging networks that provides protocols interoperability and data federation services. It is an extensible plugin system that supports standard approaches (DICOM and XDS-I), but is also capable of supporting private protocols. The framework is being used in the Dicoogle Open Source PACS.

  9. From integrated control to integrated farming, an experimental approach

    NARCIS (Netherlands)

    Vereijken, P.H.

    1989-01-01

    Integrated control or integrated pest management (IPM), as envisaged originally, is not being practised to any large extent in arable farming, notwithstanding considerable research efforts. The reasons for this are discussed. A more basic approach called integrated farming is suggested. Preliminary

  10. Clear Channel Assessment in Integrated Medical Environments

    Directory of Open Access Journals (Sweden)

    Hara Shinsuke

    2008-01-01

    Full Text Available Abstract Complementary WLAN and WPAN technologies as well as other wireless technologies will play a fundamental role in the medical environments to support ubiquitous healthcare delivery. This paper investigates clear channel assessment (CCA and its impact on the coexistence of WLAN (IEEE 802.11 high rate direct sequence spread spectrum (HR/DSSS PHY and WPAN (IEEE 802.15.4b in the 2.4 GHz industrial, scientific, and medical (ISM band. We derived closed-form expressions of both energy-based CCA and feature-based CCA. We qualified unequal sensing abilities between them and termed this inequality asymmetric CCA, which is different from the traditional "hidden node" or "exposed node" issues in the homogeneous network. The energy-based CCA was considered in the considered integrated medical environment because the 2.4 GHz ISM band is too crowded to apply feature-based CCA. The WPAN is oversensitive to the 802.11 HR/DSSS signals and the WLAN is insensitive to the 802.15.4b signals. Choosing an optimal CCA threshold requires some prior knowledge of the underlying signals. In the integrated medical environment we considered here, energy-based CCA can effectively avoid possible packet collisions when they are close within the "heterogeneous exclusive CCA range" (HECR. However, when they are separated beyond the HECR, WPAN can still sense the 802.11 HR/DSSS signals, but WLAN loses its sense to the 802.15.4b signals. The asymmetric CCA leads to WPAN traffic in a position secondary to WLAN traffic.

  11. Integrated Medical Model Project - Overview and Summary of Historical Application

    Science.gov (United States)

    Myers, J.; Boley, L.; Butler, D.; Foy, M.; Goodenow, D.; Griffin, D.; Keenan, A.; Kerstman, E.; Melton, S.; McGuire, K.; hide

    2015-01-01

    Introduction: The Integrated Medical Model (IMM) Project represents one aspect of NASA's Human Research Program (HRP) to quantitatively assess medical risks to astronauts for existing operational missions as well as missions associated with future exploration and commercial space flight ventures. The IMM takes a probabilistic approach to assessing the likelihood and specific outcomes of one hundred medical conditions within the envelope of accepted space flight standards of care over a selectable range of mission capabilities. A specially developed Integrated Medical Evidence Database (iMED) maintains evidence-based, organizational knowledge across a variety of data sources. Since becoming operational in 2011, version 3.0 of the IMM, the supporting iMED, and the expertise of the IMM project team have contributed to a wide range of decision and informational processes for the space medical and human research community. This presentation provides an overview of the IMM conceptual architecture and range of application through examples of actual space flight community questions posed to the IMM project. Methods: Figure 1 [see document] illustrates the IMM modeling system and scenario process. As illustrated, the IMM computational architecture is based on Probabilistic Risk Assessment techniques. Nineteen assumptions and limitations define the IMM application domain. Scenario definitions include crew medical attributes and mission specific details. The IMM forecasts probabilities of loss of crew life (LOCL), evacuation (EVAC), quality time lost during the mission, number of medical resources utilized and the number and type of medical events by combining scenario information with in-flight, analog, and terrestrial medical information stored in the iMED. In addition, the metrics provide the integrated information necessary to estimate optimized in-flight medical kit contents under constraints of mass and volume or acceptable level of mission risk. Results and Conclusions

  12. Machine learning approaches in medical image analysis

    DEFF Research Database (Denmark)

    de Bruijne, Marleen

    2016-01-01

    Machine learning approaches are increasingly successful in image-based diagnosis, disease prognosis, and risk assessment. This paper highlights new research directions and discusses three main challenges related to machine learning in medical imaging: coping with variation in imaging protocols......, learning from weak labels, and interpretation and evaluation of results....

  13. Medical practice variations: changing the theoretical approach.

    NARCIS (Netherlands)

    Westert, G.P.; Groenewegen, P.P.

    1999-01-01

    Variations in medical practice are well documented, but there has been less progress in explaining these variations. This paper discusses the existing theories and hypotheses and concludes that a change in theoretical approach is required, to one that more directly highlights the social context

  14. Integrated VCOs for Medical Implant Transceivers

    Directory of Open Access Journals (Sweden)

    Ahmet Tekin

    2008-01-01

    Full Text Available The 402–405 MHz medical implant communication service (MICS band has recently been allocated by the US Federal Communication Commission (FCC with the potential to replace the low-frequency inductive coupling techniques in implantable devices. This band was particularly chosen to provide full-integration, low-power, faster data transfer, and longer communication range. This paper investigates the design of a voltage-controlled oscillator (VCO that will be an essential building block of such wireless implantable devices operating in the MICS service band. Three different integrated quadrature VCOs that meet the requirements of the MICS standard are designed in 0.18 μm TSMC CMOS process to propose an optimum choice. Their performances in terms of power consumption, die area, linearity, and phase noise are compared. The fabricated VCOs are a four-stage differential ring VCO, an LC tank VCO directly loaded with a poly-phase filter, and an 800 MHz LC tank VCO with a high-frequency master-slave divider. All three architectures target a VCO gain of Kvco = 15 MHz/V with 3 calibration control and 2 frequency-shift keying (FSK control signals and are designed for 1.5 V supply voltage in a 0.18-μm standard CMOS process.

  15. The dynamical systems approach to numerical integration

    Science.gov (United States)

    Wisdom, Jack

    2018-03-01

    The dynamical systems approach to numerical integration is reviewed and extended. The new method is compared to some alternative methods based on the Lie series approach. The test problem is the motion of the outer planets. The algorithms developed using the dynamical systems approach perform well.

  16. Physiotherapy as one column of an integrative and interdisciplinary medical approach--impact of the introduction of diagnosis related groups in Germany.

    Science.gov (United States)

    Romeyke, Tobias; Scheuer, Hans Christoph; Stummer, Harald

    2013-12-01

    To investigate the introduction of case tariff fee remuneration - as required by the current system - and its influence on patient satisfaction with the provision of physiotherapeutic treatment in an acute hospital aligned on a holistic, interdisciplinary therapeutic approach. Randomised controlled study with a total of 4598 patients were interviewed. No case tariff fee system was used during the years 2004 to 2006. The data were compared with the results of interviews that took place during 2007 and 2008 (use of DRGs). The results of this study are based on the largest survey performed to date of patient satisfaction with physiotherapeutic treatment in acute care focusing on a holistic interdisciplinary approach. In-patients being treated under DRG conditions were compared with a control group for whom the DRG system had not been applied. The target parameter of the study, which took more than five years, was the determination of patient satisfaction with the physiotherapeutic interventions. There were no significant differences between the two groups in respect of satisfaction with the physiotherapeutic treatments received. Regarding the outcome parameter encouragement to take more exercise, a significant change could be demonstrated under DRG conditions. Physiotherapeutic interventions play an important role in the provision of interdisciplinary care. In particular, the holistic perception of the patient, the interdisciplinary approach to complex diseases, and the requirements of the DRG system on the care provider can exert a positive influence on outcome quality. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Operationalizing the integrated landscape approach in practice

    Directory of Open Access Journals (Sweden)

    Olivia E. Freeman

    2015-03-01

    the process of taking a landscape approach. Drawing on a review of the literature, we identify and discuss three different kinds of landscape approaches: using the landscape scale, a sectoral landscape approach, and an integrated landscape approach. Focusing on an integrated landscape approach, we examine five concepts to help characterize landscape approaches: multifunctionality, transdisciplinarity, participation, complexity, and sustainability. For each term, a continuum of application exists. To help improve and move the integrated landscape approach more toward operationalization, more focus needs to be placed on the process of taking the approach. Although the process can be implemented in a range of ways, in a more integrated approach it will require explicitly defined objectives as well as a clear understanding of what is meant by multifunctionality and sustainability. It will also require collaborative participation, transdisciplinarity/cross-sectoral approaches, managing for adaptive capacity, and applying an iterative process to address the inherent complexity within the system. Although these concepts are not new, we present continuums on which they can exist, allowing for clarification and distinctions to be made regarding what it means to take a landscape approach.

  18. Integrated reclamation: Approaching ecological function?

    Science.gov (United States)

    Ann L. Hild; Nancy L. Shaw; Ginger B. Paige

    2009-01-01

    Attempts to reclaim arid and semiarid lands have traditionally targeted plant species composition. Much research attention has been directed to seeding rates, species mixes and timing of seeding. However, in order to attain functioning systems, attention to structure and process must compliment existing efforts. We ask how to use a systems approach to enhance...

  19. Beyond biological monitoring: an integrated approach

    NARCIS (Netherlands)

    Verdonschot, P.F.M.

    2006-01-01

    Concluding discussion ‘Beyond Biological Monitoring: An Integrated Approach’ of the section New tools and strategies for river ecology evaluation – presents decision making on what constitutes a significant environmental change; predictive modelling approaches; evaluating fluvial functioning (FFI),

  20. Towards an Integrated Approach o Cohesion and Coherence in ...

    African Journals Online (AJOL)

    ... an integrated approach is proposed as a viable approach to cohesion and coherence in interlingual subtitling. Advantages and implications of this integrated approach are highlighted for further research. Keywords: Integrated Approach, Cohesion, Coherence, Interlingual Subtitling, Metafunctional Semiotic Theory ...

  1. Towards an integrated management of health physics and medical physics

    International Nuclear Information System (INIS)

    Mommaert, Chantal; Rogge, Frank; Cortenbosch, Geert; Schmitz, Frederic

    2007-01-01

    AVN is a licensed body that performs health physics control in different types of installations, from large nuclear facilities to small dentist cabinets. AVN can also provide medical physics services for the quality control of, for instance, medical devices used in a radiology or nuclear medicine department. Radiation protection for personnel and environment (health physics) and radiation protection for the patient (medical physics) are usually treated separately, using different referential documents, such as the European Directives 96/29/Euratom for health physics and 97/43/Euratom for medical physics. This difference is also clearly reflected in the Belgium legislation (two types of accreditation/licence for inspectors, different chapters in the law,..) From a practical point of view it is sometimes rather difficult to split the task 'on site' during an inspection. An RX system not complying with radiation protection criteria can definitively affect the patient as well as the workers. On the other hand, the hospitals, cannot easily differentiate these two tasks because they are not fully aware of the legislation and they are mixing both. Taking into account the health physics guidelines as well as medical physics guidelines, we have decided to move to an integrated approach of these two concepts. (orig.)

  2. An integral approach to compliance.

    Science.gov (United States)

    Goddard, T G

    2000-08-01

    Financial managers of managed care organizations should structure their compliance plans to conform with requirements shaped by forces such as judicial decisions and extralegal standards for managed care operations, in addition to state and Federal laws and regulations. In addition to researching the law and training employees, an integral compliance plan should include monitoring organizational systems that can encourage or impede compliance, measuring employees' motivation to adhere to compliance standards, and modifying corporate culture to support compliance goals. Managed care organizations should empower compliance officers with a broad range of tools to assess and improve compliance efforts, or risk having organizational decisions examined externally through the lens of an onerous, dynamic system of laws and judicial decisions.

  3. Statistical inference an integrated approach

    CERN Document Server

    Migon, Helio S; Louzada, Francisco

    2014-01-01

    Introduction Information The concept of probability Assessing subjective probabilities An example Linear algebra and probability Notation Outline of the bookElements of Inference Common statistical modelsLikelihood-based functions Bayes theorem Exchangeability Sufficiency and exponential family Parameter elimination Prior Distribution Entirely subjective specification Specification through functional forms Conjugacy with the exponential family Non-informative priors Hierarchical priors Estimation Introduction to decision theoryBayesian point estimation Classical point estimation Empirical Bayes estimation Comparison of estimators Interval estimation Estimation in the Normal model Approximating Methods The general problem of inference Optimization techniquesAsymptotic theory Other analytical approximations Numerical integration methods Simulation methods Hypothesis Testing Introduction Classical hypothesis testingBayesian hypothesis testing Hypothesis testing and confidence intervalsAsymptotic tests Prediction...

  4. Functional integral approach to classical statistical dynamics

    International Nuclear Information System (INIS)

    Jensen, R.V.

    1980-04-01

    A functional integral method is developed for the statistical solution of nonlinear stochastic differential equations which arise in classical dynamics. The functional integral approach provides a very natural and elegant derivation of the statistical dynamical equations that have been derived using the operator formalism of Martin, Siggia, and Rose

  5. Functional integral approach to classical statistical dynamics

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, R.V.

    1980-04-01

    A functional integral method is developed for the statistical solution of nonlinear stochastic differential equations which arise in classical dynamics. The functional integral approach provides a very natural and elegant derivation of the statistical dynamical equations that have been derived using the operator formalism of Martin, Siggia, and Rose.

  6. The Integrated Medical Model: Outcomes from Independent Review

    Science.gov (United States)

    Myers, J.; Garcia, Y.; Griffin, D.; Arellano, J.; Boley, L.; Goodenow, D. A.; Kerstman, E.; Reyes, D.; Saile, L.; Walton, M.; hide

    2017-01-01

    In 2016, the Integrated Medical Model (IMM) v4.0 underwent an extensive external review in preparation for transition to an operational status. In order to insure impartiality of the review process, the Exploration Medical Capabilities Element of NASA's Human Research Program convened the review through the Systems Review Office at NASA Goddard Space Flight Center (GSFC). The review board convened by GSFC consisted of persons from both NASA and academia with expertise in the fields of statistics, epidemiology, modeling, software development, aerospace medicine, and project management (see Figure 1). The board reviewed software and code standards, as well as evidence pedigree associated with both the input and outcomes information. The board also assesses the models verification, validation, sensitivity to parameters and ability to answer operational questions. This talk will discuss the processes for designing the review, how the review progressed and the findings from the board, as well as summarize the IMM project responses to those findings. Overall, the board found that the IMM is scientifically sound, represents a necessary, comprehensive approach to identifying medical and environmental risks facing astronauts in long duration missions and is an excellent tool for communication between engineers and physicians. The board also found IMM and its customer(s) should convene an additional review of the IMM data sources and to develop a sustainable approach to augment, peer review, and maintain the information utilized in the IMM. The board found this is critically important because medical knowledge continues to evolve. Delivery of IMM v4.0 to the Crew Health and Safety (CHS) Program will occur in the 2017. Once delivered for operational decision support, IMM v4.0 will provide CHS with additional quantitative capability in to assess astronaut medical risks and required medical capabilities to help drive down overall mission risks.

  7. Integrating Community Health Workers Into Medical Homes.

    Science.gov (United States)

    Rogers, Elizabeth A; Manser, Sarah Turcotte; Cleary, Joan; Joseph, Anne M; Harwood, Eileen M; Call, Kathleen T

    2018-01-01

    Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook a qualitative study to (1) identify facilitators and barriers to utilizing a CHW model among PCMHs in Minnesota, and (2) define roles played by this workforce within the PCMH team. We conducted 51 semistructured, key-informant interviews of clinic leaders, clinicians, care coordinators, CHWs, and staff from 9 clinics (5 with community health workers, 4 without). Qualitative analysis consisted of thematic coding aligned with interview topics. Four key conceptual themes emerged as facilitators and barriers to utilizing a CHW model: the presence of leaders with knowledge of CHWs who championed the model, a clinic culture that favored piloting innovation vs maintaining established care models, clinic prioritization of patients' nonmedical needs, and leadership perceptions of sustainability. These health care workers performed common and clinic-specific roles that included outreach, health education and coaching, community resource linkage, system navigation, and facilitating communication between clinician and patient. We identified facilitators and barriers to adopting CHW roles as part of PCMH care teams in Minnesota and documented their roles being played in these settings. Our findings can be used when considering strategies to enhance utilization and integration of this emerging workforce. © 2018 Annals of Family Medicine, Inc.

  8. Integrative Approach to Psoriasis Vulgaris.

    Science.gov (United States)

    Ljubenovic, Milanka; Lazarevic, Viktor; Golubovic, Masa; Binic, Ivana

    2017-12-19

    In this article, we present a literature review of the most popular and commonly used therapeutic procedures belonging to complementary and alternative medicine, which is part of the modern concept of integrative medicine, used in the treatment of psoriasis. Psoriasis is a chronic, systemic, inflammatory disease wherein skin changes are the most visible sign. It occurs in approximately 1% to 3% of the world population, and the National Psoriasis Foundation of the United States estimates the number of patients in the whole world at about 125 million. Psoriasis primarily affects the skin, burdening patients with inflamed, pruritic, and sometimes painful lesions covered with whitish scales that last for years. Because of its prevalence in the general population, diversity of the clinical picture (from minimal and localized lesions without subjective symptoms to life-threatening conditions), and disease duration (practically a lifetime), psoriasis is a disease that has become a focus of modern medicine, and therapeutic options for the treatment of psoriasis are currently very numerous and diverse. Conventional treatment of psoriasis is guided by the so-called principle of "steps," where treatment options are applied according to the severity of illness assessed by a physician. Apart from the official therapy for psoriasis, as it is defined and understood in modern developed societies, there exists in parallel a great number of traditional, complementary, and alternative psoriasis treatments, which are based on the beliefs, experiences, and theories inherent to different cultures; in this article, we have analyzed the literature related to some of these procedures.

  9. Interactive remote medical curriculum through creative technology integration - biomed 2013.

    Science.gov (United States)

    Orndorff, Brent; Waite, Gabi

    2013-01-01

    By combining traditional classroom instruction with web-based educational technologies, distance education has been a reality for many years. However, limitations remain in established technologies that restrict the types of courses offered through this medium. This was the motivation for the Interactive Remote Course Delivery (IRCD) system at the Indiana University School of Medicine and our work aimed to overcome these limitations in order to allow a more interactive learning experience. What began as a need to deliver an interactive remote physiology course spurred several developments that may have the power to change the ways in which people learn, collaborate and communicate remotely. The result of extensive research brought stimulating discoveries leading to a new approach integrating separate technologies, including the combination of web-based collaborative software Adobe Connect with Polycom videoconferencing. By experimenting with the integration of these technologies we have enhanced the level of interactivity allowing the medical school curriculum to be delivered remotely.

  10. 'Medical ethics'--an alternative approach.

    Science.gov (United States)

    Haldane, J J

    1986-01-01

    Contemporary medical ethics is generally concerned with the application of ethical theory to medico-moral dilemmas and with the critical analysis of the concepts of medicine. This paper presents an alternative programme: the development of a medical philosophy which, by taking as its starting point the two questions: what is man? and, what constitutes goodness in life? offers an account of health as one of the primary concepts of value. This view of the subject resembles that implied by ancient theories of goodness, and in later sections of the paper it is shown how Aristotle points us towards a coherent theory of human nature as psycho-physical, which overcomes the inadequacies of dualism and physicalist reductionism. What is on offer therefore, is the prospect of an integrated account of human nature and of what constitutes its flourishing: to be healthy is to be an active unity-of-parts in equilibrium. PMID:3761336

  11. Merging Systems: Integrating Home Visitation and the Family-Centered Medical Home

    OpenAIRE

    Tschudy, Megan M.; Toomey, Sara L.; Cheng, Tina L.

    2013-01-01

    To improve the health of children and bend the health care cost curve we must integrate the individual and population approaches to health and health care delivery. The 2012 Institute of Medicine (IOM) report Primary Care and Public Health: Exploring Integration to Improve Population Health laid out the continuum for integration of primary care and public health stretching from isolation to merging systems. Integration of the family-centered medical home (FCMH) and home visitation (HV) would ...

  12. Achieving Medical Currency via Selected Staff Integration in Civilian and Veterans Administration Medical Facilities

    Science.gov (United States)

    2012-10-01

    medical license as long as care is delivered in a military facility.26 Hurdles—Liability Medical malpractice also presents a formidable challenge. In...AIR UNIVERSITY AIR WAR COLLEGE Achieving Medical Currency via Selected Staff Integration in Civilian and Veterans Administration... Medical Facilities THOMAS W. HARRELL Colonel, USAF, MC, SFS Air War College Maxwell Paper No. 68 Maxwell Air Force Base, Alabama

  13. Curriculum Integration Using Enterprise Resource Planning: An Integrative Case Approach

    Science.gov (United States)

    Cannon, David M.; Klein, Helen A; Koste, Lori L.; Magal, Simha R.

    2004-01-01

    Efforts to achieve greater curriculum integration in schools of business have included team teaching, student group projects, multidisciplinary cases, and, more recently, the use of enterprise resource planning (ERP) systems. Although these approaches are beneficial, they tend to be implemented on an ad hoc basis rather than through curriculum…

  14. [Medical tourism and travel - an interdisciplinary approach].

    Science.gov (United States)

    Freyer, W; Kim, B-S

    2014-01-01

    Medical tourism (or medical travel, international patient service, cross-border or global health care) is a new current phenomenon with increasing relevance for the two disciplines of medicine and tourism. Both sides hope to improve their reputation and image, as well as to increase their revenues and rate of employment; furthermore, they want to provide better care and service for patients and tourists: Medical tourism can close the gap of the health care system at home, providing better quality, quicker access and cheaper procedures abroad, also with treatments, not - legally - available in the sending country. For the tourism sector it broadens the variety of tourism products and supply of the host country and combines medical treatments and recovery with an attractive stay in a tourism destination for patients and their companions. But in spite of all popularity of this new type of tourism and treatment, there is quite a lack of theory and academic analysis. This article outlines the status quo of scientific research both from a medical and tourism point of view. This interdisciplinary method of approach is based mainly on a state-of-the art review of the current literature. There is a great need for more scientific research in the field of medical tourism, based on the common knowledge of both disciplines tourism and medicine. First there is neither an internationally agreed definition nor a common methodology for data collection. So the real impact of touristic and medical services both for the source and for the receiving countries is un-known and imprecise. Second the internal processes of the health system have to be adapted to the needs of international patients, e. g., medical fee schedule, billing, language, inter-cultural qualifications of the staff. Moreover the whole service chain has to be taken into account, especially the pre- and post-processes, which mostly start or end abroad. Here quality standards as well as accreditations are current

  15. The integrated curriculum in medical education: AMEE Guide No. 96.

    Science.gov (United States)

    Brauer, David G; Ferguson, Kristi J

    2015-04-01

    The popularity of the term "integrated curriculum" has grown immensely in medical education over the last two decades, but what does this term mean and how do we go about its design, implementation, and evaluation? Definitions and application of the term vary greatly in the literature, spanning from the integration of content within a single lecture to the integration of a medical school's comprehensive curriculum. Taking into account the integrated curriculum's historic and evolving base of knowledge and theory, its support from many national medical education organizations, and the ever-increasing body of published examples, we deem it necessary to present a guide to review and promote further development of the integrated curriculum movement in medical education with an international perspective. We introduce the history and theory behind integration and provide theoretical models alongside published examples of common variations of an integrated curriculum. In addition, we identify three areas of particular need when developing an ideal integrated curriculum, leading us to propose the use of a new, clarified definition of "integrated curriculum", and offer a review of strategies to evaluate the impact of an integrated curriculum on the learner. This Guide is presented to assist educators in the design, implementation, and evaluation of a thoroughly integrated medical school curriculum.

  16. CANDU plant life management - An integrated approach

    International Nuclear Information System (INIS)

    Hopkins, J.R.

    1998-01-01

    An integrated approach to plant life management has been developed for CANDU reactors. Strategies, methods, and procedures have been developed for assessment of critical systems structures and components and for implementing a reliability centred maintenance program. A Technology Watch program is being implemented to eliminate 'surprises'. Specific work has been identified for 1998. AECL is working on the integrated program with CANDU owners and seeks participation from other CANDU owners

  17. QUANTITATIVE СHARACTERISTICS OF COMPLEMENTARY INTEGRATED HEALTH CARE SYSTEM AND INTEGRATED MEDICATION MANAGEMENT INFORMATION SYSTEM

    Directory of Open Access Journals (Sweden)

    L. Yu. Babintseva

    2015-05-01

    i mportant elements of state regulation of the pharmaceutical sector health. For the first time creation of two information systems: integrated medication management infor mation system and integrated health care system in an integrated medical infor mation area, operating based on th e principle of complementarity was justified. Global and technological coefficients of these systems’ functioning were introduced.

  18. Integrated software system for improving medical equipment management.

    Science.gov (United States)

    Bliznakov, Z; Pappous, G; Bliznakova, K; Pallikarakis, N

    2003-01-01

    The evolution of biomedical technology has led to an extraordinary use of medical devices in health care delivery. During the last decade, clinical engineering departments (CEDs) turned toward computerization and application of specific software systems for medical equipment management in order to improve their services and monitor outcomes. Recently, much emphasis has been given to patient safety. Through its Medical Device Directives, the European Union has required all member nations to use a vigilance system to prevent the reoccurrence of adverse events that could lead to injuries or death of patients or personnel as a result of equipment malfunction or improper use. The World Health Organization also has made this issue a high priority and has prepared a number of actions and recommendations. In the present workplace, a new integrated, Windows-oriented system is proposed, addressing all tasks of CEDs but also offering a global approach to their management needs, including vigilance. The system architecture is based on a star model, consisting of a central core module and peripheral units. Its development has been based on the integration of 3 software modules, each one addressing specific predefined tasks. The main features of this system include equipment acquisition and replacement management, inventory archiving and monitoring, follow up on scheduled maintenance, corrective maintenance, user training, data analysis, and reports. It also incorporates vigilance monitoring and information exchange for adverse events, together with a specific application for quality-control procedures. The system offers clinical engineers the ability to monitor and evaluate the quality and cost-effectiveness of the service provided by means of quality and cost indicators. Particular emphasis has been placed on the use of harmonized standards with regard to medical device nomenclature and classification. The system's practical applications have been demonstrated through a pilot

  19. Integrated Disability Management: Implementing a Customized Whole-Person Approach.

    Science.gov (United States)

    Bruen, Phil

    2016-01-01

    This article describes how incorporating integrated disability management can address business challenges. It includes case studies featuring organizations that used a "whole-person approach" to result in (1) greater and more effective communication and reporting, (2) more satisfied and productive employees and (3) cost savings through quicker return to work when legally and medically appropriate, all in alignment with the particular needs of a given firm. One size most definitely does not fit all.

  20. Medical contribution to the comprehensive approach.

    Science.gov (United States)

    Fletcher, J M

    2011-12-01

    The coordination of the Military, Diplomatic and Economic/Development levers of power, the so-called "hard" and "soft" powers, to bring about the strategic aims of governments, supported by Non-Governmental Organisations and international organisations, is commonly known as the Comprehensive Approach (CA). The CA is now part of both NATO and UK military doctrine and concepts development. This article describes how medical branch HQ Allied Rapid Reaction Corp, as part of the HQs work to operationalise the CA, has sought and developed training opportunities to improve individual skill-sets to enable the branch to better contribute to the CA process.

  1. Integrating gender into a basic medical curriculum.

    NARCIS (Netherlands)

    Verdonk, P.; Mans, L.J.L.; Lagro-Janssen, A.L.M.

    2005-01-01

    INTRODUCTION: In 1998, gaps were found to exist in the basic medical curriculum of the Radboud University Nijmegen Medical Centre regarding health-related gender differences in terms of biological, psychological and social factors. After screening the curriculum for language, content and context,

  2. Systems analysis with an integrated medical analysis system (IMAS)

    Science.gov (United States)

    Koelsch, John; Mabry, Susan L.; Rodriquez, Samuel; Takemura, Paul

    1998-05-01

    This paper describes the integrated medical analysis system (IMAS) The evolving system consists of an integrated suite of models and tools providing quantitative and dynamic analysis from multiple physiological function models, clinical care patient input, medical device data, and integrated medical systems. The system is being developed for requirements definition, patient assessment, control theory, training, instrumentation testing and validation. Traditionally, human models and simulations are performed on small scale, isolated problems, usually consisting of detached mathematical models or measurements studies. These systems are not capable of portraying the interactive effects of such systems and certainly are not capable of integrating multiple external entities such as device data, patient data, etc. The human body in and of itself is a complex, integrated system. External monitors, treatments, and medical conditions interact at yet another level. Hence, a highly integrated, interactive simulation system with detailed subsystem models is required for effective quantitative analysis. The current prototype emphasizes cardiovascular, respiratory and thermoregulatory functions with integration of patient device data. Unique system integration of these components is achieved through four facilitators. These facilitators include a distributed interactive computing architecture, application of fluid and structural engineering principles to the models, real-time scientific visualization, and application of strong system integration principles. The IMAS forms a complex analytical tool with emphasis on integration and interaction at multiple levels between components. This unique level of integration and interaction facilitates quantitative analysis for multiple purposes and varying levels of fidelity. An overview of the project and preliminary findings are introduced.

  3. Integrated Approach to User Account Management

    Science.gov (United States)

    Kesselman, Glenn; Smith, William

    2007-01-01

    IT environments consist of both Windows and other platforms. Providing user account management for this model has become increasingly diffi cult. If Microsoft#s Active Directory could be enhanced to extend a W indows identity for authentication services for Unix, Linux, Java and Macintosh systems, then an integrated approach to user account manag ement could be realized.

  4. Advancing Instructional Communication: Integrating a Biosocial Approach

    Science.gov (United States)

    Horan, Sean M.; Afifi, Tamara D.

    2014-01-01

    Celebrating 100 years of the National Communication Association necessitates that, as we commemorate our past, we also look toward our future. As part of a larger conversation about the future of instructional communication, this essay reinvestigates the importance of integrating biosocial approaches into instructional communication research. In…

  5. Complementary and Integrative Approaches for Pediatric Headache.

    Science.gov (United States)

    Kedia, Sita

    2016-02-01

    In this article, the use of complementary and integrative medicine for the management of pediatric headache is reviewed. Despite limited numbers of studies for pediatric headaches, children and families seek these services. Integrative medicine focuses on treating the whole person, integrating conventional medicine with mind-body-spirit methods. Nutriceuticals include dietary supplements in the form of vitamins (vitamin D), minerals (magnesium), coenzyme Q, butterbur, and melatonin. Acupuncture, stimulation, physical therapy and Transcutaneous Electrical Nerve Stimulations (TENS) or Transcranial Magnetic Stimulation (TMS) may also be useful in selected patients. The efficacy of all these therapeutic alternatives in pediatric headache is presented here. Primary care providers, neurologists, and headache specialists alike need to be informed of such interventions and integrate these approaches, when appropriate, in the management of children with headaches. Copyright © 2016. Published by Elsevier Inc.

  6. Integrating ultrasound into modern medical curricula.

    Science.gov (United States)

    Patel, Shilpan G; Benninger, Brion; Mirjalili, S Ali

    2017-05-01

    Ultrasonography is widely practiced in many disciplines. It is becoming increasingly important to design well-structured curricula to introduce imaging to students during medical school. This review aims to analyze the literature for evidence of how ultrasonography has been incorporated into anatomy education in medical school curricula worldwide. A literature search was conducted using multiple databases with the keywords: "Ultrasound OR Ultrasonographic examination*" and "Medical student* OR Undergraduate teaching* OR Medical education*" and "Anatomy* OR Living anatomy* OR Real-time anatomy.*" This review found that ultrasound curricula vary in stage of implementation, course length, number of sessions offered to students as well as staffing and additional course components. Most courses consisted of didactic lectures supplemented with demonstration sessions and/or hands-on ultrasound scanning sessions. The stage of course implementation tended to depend on the aim of the course; introductory courses were offered earlier in a student's career. Most courses improved student confidence and exam performance, and more junior students tended to benefit more from learning anatomy with ultrasound guidance rather than learning clinical examination skills. Students tended to prefer smaller groups when learning ultrasound to get more access to using the machines themselves. Ultrasonography is an important skill, which should be taught to medical students early in their careers as it facilitates anatomical education and is clinically relevant, though further objective research required to support the use of ultrasound education as a tool to improve clinical examination skills in medical students. Clin. Anat. 30:452-460, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  7. Development of an integrated medical supply information system

    Science.gov (United States)

    Xu, Eric; Wermus, Marek; Blythe Bauman, Deborah

    2011-08-01

    The integrated medical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integrated medical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to manage medical supply and better patient services.

  8. Performance improvement integration: a whole systems approach.

    Science.gov (United States)

    Page, C K

    1999-02-01

    Performance improvement integration in health care organizations is a challenge for health care leaders. Required for accreditation by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission), performance improvement (PI) can be designed as a sustainable model for performance to survive in a turbulent period. Central Baptist Hospital developed a model for PI that focused on strategy established by the leadership team, delineated responsibility through the organizational structure of shared governance, and accountability for outcomes evidenced through the organization's profitability. Such an approach integrated into the culture of the organization can produce positive financial margins, positive customer satisfaction, and commendations from the Joint Commission.

  9. Integral, measure and derivative a unified approach

    CERN Document Server

    Shilov, G E

    2012-01-01

    This graduate-level textbook and monograph defines the functions of a real variable through consistent use of the Daniell scheme, offering a rare and useful alternative to customary approaches. The treatment can be understood by any reader with a solid background in advanced calculus, and it features many problems with hints and answers. ""The exposition is fresh and sophisticated,"" declared Sci-Tech Book News, ""and will engage the interest of accomplished mathematicians."" Part one is devoted to the integral, moving from the Reimann integral and step functions to a general theory, and obta

  10. Some Integral Inequalities Using Quantum Calculus Approach

    Directory of Open Access Journals (Sweden)

    Muhammad Uzair Awan

    2017-11-01

    Full Text Available The aim of this paper is to introduce a new class of preinvex functions which is called as generalized beta preinvex functions. We show that this class includes some other new classes of preinvex functions. We derive some new integral inequalities using the approach of quantum calculus. These integral inequalities involve generalized preinvex functions and q-Euler-Beta functions. Our results can be viewed as new quantum estimates for trapezoidal like inequalities. Some new special cases are also discussed which can be deduced from the main results of the paper.

  11. Integrated Artificial Intelligence Approaches for Disease Diagnostics.

    Science.gov (United States)

    Vashistha, Rajat; Chhabra, Deepak; Shukla, Pratyoosh

    2018-06-01

    Mechanocomputational techniques in conjunction with artificial intelligence (AI) are revolutionizing the interpretations of the crucial information from the medical data and converting it into optimized and organized information for diagnostics. It is possible due to valuable perfection in artificial intelligence, computer aided diagnostics, virtual assistant, robotic surgery, augmented reality and genome editing (based on AI) technologies. Such techniques are serving as the products for diagnosing emerging microbial or non microbial diseases. This article represents a combinatory approach of using such approaches and providing therapeutic solutions towards utilizing these techniques in disease diagnostics.

  12. Integrative veterinary medical education and consensus guidelines ...

    African Journals Online (AJOL)

    Integrative veterinary medicine (IVM) describes the combination of complementary and alternative therapies with conventional care and is guided by the best available evidence. Veterinarians frequently encounter questions about complementary and alternative veterinary medicine (CAVM) in practice, and the general ...

  13. PROJECT BASED ORGANIZATION - AN INTEGRATED APPROACH

    Directory of Open Access Journals (Sweden)

    Claudiu George BOCEAN

    2011-01-01

    Full Text Available As a consequence of globalization, application of new technologies, turbulent economic environment, the uncertainties affecting markets, organizations must cope with ongoing transformational process. In this context, the project-based organization (PBO emerges as an ideal alternative of organizational structure to deal with the emerging features of the temporary and unique demands, within a complex market. This paper brings a new approach trough integration of general management functions with project management activities. The methodology of the proposed ap-proach covers the whole Deming PDCA (Plan, Do, Check, Act cycle, involving quality management in project-based organization's success.

  14. Introduction to solid mechanics an integrated approach

    CERN Document Server

    Lubliner, Jacob

    2017-01-01

    This expanded second edition presents in one text the concepts and processes covered in statics and mechanics of materials curricula following a systematic, topically integrated approach. Building on the novel pedagogy of fusing concepts covered in traditional undergraduate courses in rigid-body statics and deformable body mechanics, rather than simply grafting them together, this new edition develops further the authors’ very original treatment of solid mechanics with additional figures, an elaboration on selected solved problems, and additional text as well as a new subsection on viscoelasticity in response to students’ feedback. Introduction to Solid Mechanics: An Integrated Approach, Second Edition, offers a holistic treatment of the depth and breadth of solid mechanics and the inter-relationships of its underlying concepts. Proceeding from first principles to applications, the book stands as a whole greater than the sum of its parts.  .

  15. Predicting Peer Nominations Among Medical Students: A Social Network Approach.

    Science.gov (United States)

    Michalec, Barret; Grbic, Douglas; Veloski, J Jon; Cuddy, Monica M; Hafferty, Frederic W

    2016-06-01

    Minimal attention has been paid to what factors may predict peer nomination or how peer nominations might exhibit a clustering effect. Focusing on the homophily principle that "birds of a feather flock together," and using a social network analysis approach, the authors investigated how certain student- and/or school-based factors might predict the likelihood of peer nomination, and the clusters, if any, that occur among those nominations. In 2013, the Jefferson Longitudinal Study of Medical Education included a special instrument to evaluate peer nominations. A total of 211 (81%) of 260 graduating medical students from the Sidney Kimmel Medical College responded to the peer nomination question. Data were analyzed using a relational contingency table and an ANOVA density model. Although peer nominations did not cluster around gender, age, or class rank, those students within an accelerated program, as well as those entering certain specialties, were more likely to nominate each other. The authors suggest that clerkships in certain specialties, as well as the accelerated program, may provide structured opportunities for students to connect and integrate, and that these opportunities may have an impact on peer nomination. The findings suggest that social network analysis is a useful approach to examine various aspects of peer nomination processes. The authors discuss implications regarding harnessing social cohesion within clinical clerkships, the possible development of siloed departmental identity and in-group favoritism, and future research possibilities.

  16. Radiobiological Implications of Fukushima Nuclear Accident for Personalized Medical Approach.

    Science.gov (United States)

    Fukunaga, Hisanori; Yokoya, Akinari; Taki, Yasuyuki; Prise, Kevin M

    2017-05-01

    On March 11, 2011, a devastating earthquake and subsequent tsunami caused serious damage to areas of the Pacific coast in Fukushima prefecture and prompted fears among the residents about a possible meltdown of the Fukushima Daiichi Nuclear Power Plant reactors. As of 2017, over six years have passed since the Fukushima nuclear crisis and yet the full ramifications of the biological exposures to this accidental release of radioactive substances remain unclear. Furthermore, although several genetic studies have determined that the variation in radiation sensitivity among different individuals is wider than expected, personalized medical approaches for Fukushima victims have seemed to be insufficient. In this commentary, we discuss radiobiological issues arising from low-dose radiation exposure, from the cell-based to the population level. We also introduce the scientific utility of the Integrative Japanese Genome Variation Database (iJGVD), an online database released by the Tohoku Medical Megabank Organization, Tohoku University that covered the whole genome sequences of 2,049 healthy individuals in the northeastern part of Japan in 2016. Here we propose a personalized radiation risk assessment and medical approach, which considers the genetic variation of radiation sensitivity among individuals, for next-step developments in radiological protection.

  17. Integrating The Integrated Skin Exam film into medical education

    OpenAIRE

    Lofgreen, Seth; Lehrer, Michael; Bennett, Paige; Garg, Amit; Dunnick, Cory A

    2016-01-01

    Abstract Background The mortality rate for melanoma continues to rise and the greatest improvement in melanoma survival is attributable to early detection with skin cancer screening exams. However, physicians feel that limited training in the examination of skin and limited clinical time both serve as barriers to adequately assess high-risk lesions. Objective To test the use of The Integrated Skin Exam film as an instructional tool to teach the examination ...

  18. Efficient integration method for fictitious domain approaches

    Science.gov (United States)

    Duczek, Sascha; Gabbert, Ulrich

    2015-10-01

    In the current article, we present an efficient and accurate numerical method for the integration of the system matrices in fictitious domain approaches such as the finite cell method (FCM). In the framework of the FCM, the physical domain is embedded in a geometrically larger domain of simple shape which is discretized using a regular Cartesian grid of cells. Therefore, a spacetree-based adaptive quadrature technique is normally deployed to resolve the geometry of the structure. Depending on the complexity of the structure under investigation this method accounts for most of the computational effort. To reduce the computational costs for computing the system matrices an efficient quadrature scheme based on the divergence theorem (Gauß-Ostrogradsky theorem) is proposed. Using this theorem the dimension of the integral is reduced by one, i.e. instead of solving the integral for the whole domain only its contour needs to be considered. In the current paper, we present the general principles of the integration method and its implementation. The results to several two-dimensional benchmark problems highlight its properties. The efficiency of the proposed method is compared to conventional spacetree-based integration techniques.

  19. Addressing uncertainties in the ERICA Integrated Approach

    International Nuclear Information System (INIS)

    Oughton, D.H.; Agueero, A.; Avila, R.; Brown, J.E.; Copplestone, D.; Gilek, M.

    2008-01-01

    Like any complex environmental problem, ecological risk assessment of the impacts of ionising radiation is confounded by uncertainty. At all stages, from problem formulation through to risk characterisation, the assessment is dependent on models, scenarios, assumptions and extrapolations. These include technical uncertainties related to the data used, conceptual uncertainties associated with models and scenarios, as well as social uncertainties such as economic impacts, the interpretation of legislation, and the acceptability of the assessment results to stakeholders. The ERICA Integrated Approach has been developed to allow an assessment of the risks of ionising radiation, and includes a number of methods that are intended to make the uncertainties and assumptions inherent in the assessment more transparent to users and stakeholders. Throughout its development, ERICA has recommended that assessors deal openly with the deeper dimensions of uncertainty and acknowledge that uncertainty is intrinsic to complex systems. Since the tool is based on a tiered approach, the approaches to dealing with uncertainty vary between the tiers, ranging from a simple, but highly conservative screening to a full probabilistic risk assessment including sensitivity analysis. This paper gives on overview of types of uncertainty that are manifest in ecological risk assessment and the ERICA Integrated Approach to dealing with some of these uncertainties

  20. Medical mall founders' satisfaction and integrated management requirements

    Science.gov (United States)

    2016-01-01

    Summary Medical malls help provide integrated medical services and the effective and efficient independent management of multiple clinics, pharmacies and other medical facilities. Primary care in an aging society is a key issue worldwide and the establishment of a new model for primary care in Japanese medical malls is needed. Understanding the requirements of integrated management that contribute to the improvement of medical mall founders' satisfaction levels will help provide better services. We conducted a questionnaire survey targeting 1840 medical facilities nationwide; 351 facilities responded (19.1%). We performed comparative analyses on founders' satisfaction levels according to years in business, department/area, founder's relationship, decision‐making system and presence/absence of liaison role. A total of 70% of medical malls in Japan have adjacent relationships with no liaison role in most cases; however, 60% of founders are satisfied. Integrated management requirements involve establishing the mall with peers from the same medical office unit or hospital, and establishing a system in which all founders can participate in decision‐making (council system) or one where each general practitioner (GP) independently runs a clinic without communicating with others. The council system can ensure the capability of general practitioners to treat many primary care patients in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd PMID:27218206

  1. Advancing medication infusion safety through the clinical integration of technology.

    Science.gov (United States)

    Gerhart, Donald; O'Shea, Kristen; Muller, Sharon

    2013-01-01

    Adverse drug events resulting from errors in prescribing or administering medications are preventable. Within a hospital system, numerous technologies are employed to address the common sources of medication error, including the use of electronic medical records, physician order entry, smart infusion pumps, and barcode medication administration systems. Infusion safety is inherently risky because of the high-risk medications administered and the lack of integration among the stand-alone systems in most institutions. Intravenous clinical integration (IVCI) is a technology that connects electronic medical records, physician order entry, smart infusion pumps, and barcode medication administration systems. It combines the safety features of an automatically programmed infusion pump (drug, concentration, infusion rate, and patient weight, all auto-programmed into the device) with software that provides visibility to real-time clinical infusion data. Our article describes the characteristics of IVCI at WellSpan Health and its impact on patient safety. The integrated infusion system has the capability of reducing medication errors, improving patient care, reducing in-facility costs, and supporting asset management. It can enhance continuous quality improvement efforts and efficiency of clinical work flow. After implementing IVCI, the institution realized a safer patient environment and a more streamlined work flow for pharmacy and nursing.

  2. Medical device integration using mobile telecommunications infrastructure.

    Science.gov (United States)

    Moorman, Bridget A; Cockle, Richard A

    2013-01-01

    Financial pressures, an aging population, and a rising number of patients with chronic diseases, have encouraged the use of remote monitoring technologies. This usually entails at least one physiological parameter measurement for a clinician. Mobile telecommunication technologies lend themselves to this functionality, and in some cases, avoid some of the issues encountered with device integration. Moreover, the inherent characteristics of the mobile telecommunications infrastructure allow a coupling of business and clinical functions that were not possible before. Table I compares and contrasts some key aspect of device integration in and out of a healthcare facility. An HTM professional may be part of the team that acquires and/or manages a system using a mobile telecommunications technology. It is important for HTM professionals to ensure the data is in a standard format so that the interfaces across this system don't become brittle and break easily if one part changes. Moreover, the security and safety considerations of the system and the data should be a primary consideration in and y purchase, with attention given to the proper environmental and encryption mechanisms. Clinical engineers and other HTM professionals are unique in that they understand the patient/clinician/device interface and the need to ensure its safety and effectiveness regardless of geographical environment.

  3. Medical records department and balanced scorecard approach.

    Science.gov (United States)

    Ajami, Sima; Ebadsichani, Afsaneh; Tofighi, Shahram; Tavakoli, Nahid

    2013-01-01

    The Medical Records Department (MRD) is an important source for evaluating and planning of healthcare services; therefore, hospital managers should improve their performance not only in the short-term but also in the long-term plans. The Balanced Scorecard (BSC) is a tool in the management system that enables organizations to correct operational functions and provides feedback around both the internal processes and the external outcomes, in order to improve strategic performance and outcomes continuously. The main goal of this study was to assess the MRD performance with BSC approach in a hospital. This research was an analytical cross-sectional study in which data was collected by questionnaires, forms and observation. The population was the staff of the MRD in a hospital in Najafabad, Isfahan, Iran. To analyze data, first, objectives of the MRD, according to the mission and perspectives of the hospital, were redefined and, second, indicators were measured. Subsequently, findings from the performance were compared with the expected score. In order to achieve the final target, the programs, activities, and plans were reformed. The MRD was successful in absorbing customer satisfaction. From a customer perspective, score in customer satisfaction of admission and statistics sections were 82% and 83%, respectively. The comprehensive nature of the strategy map makes the MRD especially useful as a consensus building and communication tool in the hospital.

  4. Medical technology in India: Tracing policy approaches.

    Science.gov (United States)

    Chakravarthi, Indira

    2013-01-01

    Medical devices and equipment have become an indispensable part of modern medical practice. Yet these medical technologies receive scant attention in the Indian context, both at the health policy level and as an area of study. There has been little attempt to systematically address the issue of equipment based medical technologies and how to regulate their use. There is paucity of primary data on the kind of medical equipment and techniques being introduced, on their need and relative usefulness, reliability, patterns of utilization, on their production, procurement, distribution, costs, and accessibility. This article reviews some of the policy issues relating to equipment based medical technology in India, in light of the specific choices and policies made during and after the colonial period in favour of modern medicine and a technology-based public health system, attempts at self-sufficiency and the current international environment with respect to the medical equipment and health-care industry.

  5. On-line integration of computer controlled diagnostic devices and medical information systems in undergraduate medical physics education for physicians.

    Science.gov (United States)

    Hanus, Josef; Nosek, Tomas; Zahora, Jiri; Bezrouk, Ales; Masin, Vladimir

    2013-01-01

    We designed and evaluated an innovative computer-aided-learning environment based on the on-line integration of computer controlled medical diagnostic devices and a medical information system for use in the preclinical medical physics education of medical students. Our learning system simulates the actual clinical environment in a hospital or primary care unit. It uses a commercial medical information system for on-line storage and processing of clinical type data acquired during physics laboratory classes. Every student adopts two roles, the role of 'patient' and the role of 'physician'. As a 'physician' the student operates the medical devices to clinically assess 'patient' colleagues and records all results in an electronic 'patient' record. We also introduced an innovative approach to the use of supportive education materials, based on the methods of adaptive e-learning. A survey of student feedback is included and statistically evaluated. The results from the student feedback confirm the positive response of the latter to this novel implementation of medical physics and informatics in preclinical education. This approach not only significantly improves learning of medical physics and informatics skills but has the added advantage that it facilitates students' transition from preclinical to clinical subjects. Copyright © 2011 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  6. Toward a quantitative approach to migrants integration

    Science.gov (United States)

    Barra, A.; Contucci, P.

    2010-03-01

    Migration phenomena and all the related issues, like integration of different social groups, are intrinsically complex problems since they strongly depend on several competitive mechanisms as economic factors, cultural differences and many others. By identifying a few essential assumptions, and using the statistical mechanics of complex systems, we propose a novel quantitative approach that provides a minimal theory for those phenomena. We show that the competitive interactions in decision making between a population of N host citizens and P immigrants, a bi-partite spin-glass, give rise to a social consciousness inside the host community in the sense of the associative memory of neural networks. The theory leads to a natural quantitative definition of migrant's "integration" inside the community. From the technical point of view this minimal picture assumes, as control parameters, only general notions like the strength of the random interactions, the ratio between the sizes of the two parties and the cultural influence. Few steps forward, toward more refined models, which include a digression on the kind of the felt experiences and some structure on the random interaction topology (as dilution to avoid the plain mean-field approach) and correlations of experiences felt between the two parties (biasing the distribution of the coupling) are discussed at the end, where we show the robustness of our approach.

  7. Effects of an integrated clinical information system on medication safety in a multi-hospital setting.

    Science.gov (United States)

    Mahoney, Charles D; Berard-Collins, Christine M; Coleman, Reid; Amaral, Joseph F; Cotter, Carole M

    2007-09-15

    The implementation of vendor-based integrated clinical information technology was studied, and its effect on medication errors throughout the medication-use process in a health care system was evaluated. The integrated systems selected for implementation included computerized physician order entry, pharmacy and laboratory information systems, clinical decision-support systems (CDSSs), electronic drug dispensing systems (EDDSs), and a bar-code point-of-care medication administration system. The primary endpoint was the reduction in related medication errors. Secondary endpoints included the reductions in medication order turnaround time and EDDS override transactions. Integrated clinical information system technology was implemented in a multihospital health care system with a phased-in approach. A positive effect of this integration on medication errors throughout the medication-use process was demonstrated. Most prescribing errors decreased significantly in the selected categories monitored, specifically drug allergy detection, excessive dosing, and incomplete or unclear orders. Pharmacists were also twice as likely to identify dosages requiring adjustment for renal insufficiency when the integrated technology was in place and more than six times as likely for drug levels outside of the therapeutic range. A positive effect on medication administration safety was also demonstrated: 73 administration-related errors were intercepted through electronic bar-code scanning for every 100,000 doses charted. Integration of clinical information system technology decreased selected types of medication errors throughout the medication-use process in a health care system and improved therapeutic drug monitoring in patients with renal insufficiency and in patients receiving drugs with narrow therapeutic ranges through the use of CDSS alerts.

  8. Integration models: multicultural and liberal approaches confronted

    Science.gov (United States)

    Janicki, Wojciech

    2012-01-01

    European societies have been shaped by their Christian past, upsurge of international migration, democratic rule and liberal tradition rooted in religious tolerance. Boosting globalization processes impose new challenges on European societies, striving to protect their diversity. This struggle is especially clearly visible in case of minorities trying to resist melting into mainstream culture. European countries' legal systems and cultural policies respond to these efforts in many ways. Respecting identity politics-driven group rights seems to be the most common approach, resulting in creation of a multicultural society. However, the outcome of respecting group rights may be remarkably contradictory to both individual rights growing out from liberal tradition, and to reinforced concept of integration of immigrants into host societies. The hereby paper discusses identity politics upturn in the context of both individual rights and integration of European societies.

  9. Quantum gravitation the Feynman path integral approach

    CERN Document Server

    Hamber, Herbert W

    2009-01-01

    The book covers the theory of Quantum Gravitation from the point of view of Feynman path integrals. These provide a manifestly covariant approach in which fundamental quantum aspects of the theory such as radiative corrections and the renormalization group can be systematically and consistently addressed. The path integral method is suitable for both perturbative as well as non-perturbative studies, and is known to already provide a framework of choice for the theoretical investigation of non-abelian gauge theories, the basis for three of the four known fundamental forces in nature. The book thus provides a coherent outline of the present status of the theory gravity based on Feynman’s formulation, with an emphasis on quantitative results. Topics are organized in such a way that the correspondence to similar methods and results in modern gauge theories becomes apparent. Covariant perturbation theory are developed using the full machinery of Feynman rules, gauge fixing, background methods and ghosts. The ren...

  10. Introduction to solid mechanics an integrated approach

    CERN Document Server

    Lubliner, Jacob

    2014-01-01

    This textbook presents for the first time in one text the concepts and processes covered in statics and mechanics of materials curricula following a systematic, topically integrated approach. Since the turn of the millennium, it has become common in engineering schools to combine the traditional undergraduate offerings in rigid-body statics (usually called “statics”) and deformable body mechanics (known traditionally as “strength of materials” or, more recently, “mechanics of materials”) into a single, introductory course in solid mechanics. Many textbooks for the new course sequentially meld pieces of existing, discrete books—sometimes, but not always, acknowledging the origin—into two halves covering Statics and Mechanics of Materials. In this volume, Professors Lubliner and Papadopoulos methodically combine the essentials of statics and mechanics of materials, illustrating the relationship of concepts throughout, into one "integrated" text. This book also: ·         Offers thorough...

  11. Pedagogic process modeling: Humanistic-integrative approach

    Directory of Open Access Journals (Sweden)

    Boritko Nikolaj M.

    2007-01-01

    Full Text Available The paper deals with some current problems of modeling the dynamics of the subject-features development of the individual. The term "process" is considered in the context of the humanistic-integrative approach, in which the principles of self education are regarded as criteria for efficient pedagogic activity. Four basic characteristics of the pedagogic process are pointed out: intentionality reflects logicality and regularity of the development of the process; discreteness (stageability in dicates qualitative stages through which the pedagogic phenomenon passes; nonlinearity explains the crisis character of pedagogic processes and reveals inner factors of self-development; situationality requires a selection of pedagogic conditions in accordance with the inner factors, which would enable steering the pedagogic process. Offered are two steps for singling out a particular stage and the algorithm for developing an integrative model for it. The suggested conclusions might be of use for further theoretic research, analyses of educational practices and for realistic predicting of pedagogical phenomena. .

  12. Integrating heterogeneous databases in clustered medic care environments using object-oriented technology

    Science.gov (United States)

    Thakore, Arun K.; Sauer, Frank

    1994-05-01

    The organization of modern medical care environments into disease-related clusters, such as a cancer center, a diabetes clinic, etc., has the side-effect of introducing multiple heterogeneous databases, often containing similar information, within the same organization. This heterogeneity fosters incompatibility and prevents the effective sharing of data amongst applications at different sites. Although integration of heterogeneous databases is now feasible, in the medical arena this is often an ad hoc process, not founded on proven database technology or formal methods. In this paper we illustrate the use of a high-level object- oriented semantic association method to model information found in different databases into an integrated conceptual global model that integrates the databases. We provide examples from the medical domain to illustrate an integration approach resulting in a consistent global view, without attacking the autonomy of the underlying databases.

  13. Novel operational approaches to support medical countmeasure response to radiological or nerve agent events

    International Nuclear Information System (INIS)

    Withcomb, R.; Adams, S.

    2009-01-01

    Presentation will highlight two unique operational approaches developed by CDC to support the US Governments rapid medical countermeasure response to radiological and nerve agent exposures. Specifically new CDC's DTPA Forward Placement Project and CHEMPACK program will be discussed and contrasted as will the planning efforts necessary to develop an optimized operational approach and integrate each of these countermeasures into a rapid medical response program whose success is dependent on collaboration of both National and local authorities.(author)

  14. Integrating new approaches to atrial fibrillation management

    DEFF Research Database (Denmark)

    Kotecha, Dipak; Breithardt, Günter; Camm, A John

    2018-01-01

    cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference...... of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new...

  15. A semantic medical multimedia retrieval approach using ontology information hiding.

    Science.gov (United States)

    Guo, Kehua; Zhang, Shigeng

    2013-01-01

    Searching useful information from unstructured medical multimedia data has been a difficult problem in information retrieval. This paper reports an effective semantic medical multimedia retrieval approach which can reflect the users' query intent. Firstly, semantic annotations will be given to the multimedia documents in the medical multimedia database. Secondly, the ontology that represented semantic information will be hidden in the head of the multimedia documents. The main innovations of this approach are cross-type retrieval support and semantic information preservation. Experimental results indicate a good precision and efficiency of our approach for medical multimedia retrieval in comparison with some traditional approaches.

  16. Holistic integrative medicine: toward a new era of medical advancement.

    Science.gov (United States)

    Fan, Daiming

    2017-03-01

    Medicine has encountered unprecedented problems associated with changes in nature, society, and environment, as well as with new human quests for survival, longevity, and health. In the meantime, the development of medicine is facing challenges that resulted from the over-division and specialization of disciplines and the fragmentation of medical knowledge. To construct a new medical system that is more suitable for human health and disease treatment, holistic integrative medicine (HIM), which regards the human body as a holistic entity, organically integrates the most advanced knowledge and theories in each medical field and the most effective practices in various clinical specialties to revise and adjust on the basis of social, environmental, and psychological conditions. HIM is the inevitable and necessary direction for the future development of medicine. In this article, we illustrated the connotation of HIM, the differences between HIM and other medical conceptions, and the practice of HIM in recent years.

  17. Integration of Computers into the Medical School Curriculum: An Example from a Microbiology Course.

    Science.gov (United States)

    Platt, Mark W.; And Others

    1994-01-01

    While the use of computers has become widespread in recent years, a unified, integrated approach to their use in the medical school curriculum has not yet emerged. Describes a program at the University of New Mexico that will phase-in computerization of its curriculum beginning in the fall of 1993. (LZ)

  18. Journal of Mind and Medical Sciences: translational and integrative mission

    OpenAIRE

    David L. Rowland; Ion G. Motofei

    2017-01-01

    Initiated four years ago, Journal of Mind and Medical Sciences (J Mind Med Sci.) established the mission to publish papers on mental and medical topics in distinct but closely interrelated domains. The editorial policy especially encourages interdisciplinary and integrative perspectives, being equally focused on basic research and clinical investigations and short reports. The journal adheres to the philosophy that high quality, original ideas and information should be readily accessibl...

  19. Undergraduate hematology – a more integrated approach

    Directory of Open Access Journals (Sweden)

    Di Carlofelice MA

    2016-11-01

    Full Text Available Matteo A Di Carlofelice,* Jack FT Cope*Faculty of Medicine, Imperial College London, London, UK*These authors contributed equally to this workAs fellow medical students we read with great interest the article by Mandan et al1 proposing a dedicated hematology rotation. The authors highlight a gap in clinical hematology teaching, particularly compared to “conventional rotations”.1 Their suggestion has merits and we agree with most of the points raised; however, propose instead for us to build on current teaching as opposed to establishing a new rotation.The integration of theoretical and practical learning was concluded to be beneficial to both teacher and student by Wrenn and Wrenn.2 In the original article it is mentioned that “clinical experience allows students to comprehend and apply this knowledge in practice, enabling the all-important integration of their learning”.1 As we agree that hematology overlaps with other specialties and therefore requires a thorough understanding, we value how a clinical attachment would be useful to solidify lecture-based teaching.View the original paper by Mandan et al.

  20. APPROACH FOR IMPROVING THE INTEGRATED SENSOR ORIENTATION

    Directory of Open Access Journals (Sweden)

    E. Mitishita

    2016-06-01

    Full Text Available The direct determination of exterior orientation parameters (EOP of aerial images via integration of the Inertial Measurement Unit (IMU and GPS is often used in photogrammetric mapping nowadays. The accuracies of the EOP depend on the accurate parameters related to sensors mounting when the job is performed (offsets of the IMU relative to the projection centre and the angles of boresigth misalignment between the IMU and the photogrammetric coordinate system. In principle, when the EOP values do not achieve the required accuracies for the photogrammetric application, the approach, known as Integrated Sensor Orientation (ISO, is used to refine the direct EOP. ISO approach requires accurate Interior Orientation Parameters (IOP and standard deviation of the EOP under flight condition. This paper investigates the feasibility of use the in situ camera calibration to obtain these requirements. The camera calibration uses a small sub block of images, extracted from the entire block. A digital Vexcel UltraCam XP camera connected to APPLANIX POS AVTM system was used to get two small blocks of images that were use in this study. The blocks have different flight heights and opposite flight directions. The proposed methodology improved significantly the vertical and horizontal accuracies of the 3D point intersection. Using a minimum set of control points, the horizontal and vertical accuracies achieved nearly one image pixel of resolution on the ground (GSD. The experimental results are shown and discussed.

  1. Radecs 99: medical environments - first approach

    International Nuclear Information System (INIS)

    Meyroneinc, S.; Ferrand, R.

    1999-01-01

    1999 is the first year when the medical subject is specifically named during a session of the RADECS conference. This initiative aims at identifying from a group of correspondents, the problems and needs linked to the irradiation of electronic systems in the medical area. A survey shows that the main needs of the medical community are: -) centralization of all the information on the subject, -) gathering of all the experience by a RADECS expert, -) the setting of a hot line dedicated to help medical staff choosing the equipment best adapted to their particular situation, and -) the setting of a certification concerning the resistance to radiation of medical equipment likely to be used under radiation (drugs injectors, respirators...)

  2. A Successful Strategy to Integrate Sex and Gender Medicine into a Newly Developed Medical Curriculum.

    Science.gov (United States)

    Ludwig, Sabine; Oertelt-Prigione, Sabine; Kurmeyer, Christine; Gross, Manfred; Grüters-Kieslich, Annette; Regitz-Zagrosek, Vera; Peters, Harm

    2015-12-01

    A new modular, outcome-based, interdisciplinary curriculum was introduced for undergraduate medical education at one of the largest European medical faculties. A key stated institutional goal was to systematically integrate sex and gender medicine and gender perspectives into the curriculum in order to foster adequate gender-related knowledge and skills for future doctors concerning the etiology, pathogenesis, clinical presentation, diagnosis, treatment, and research of diseases. A change agent was integrated directly into the curriculum development team to facilitate interactions with all key players of the curricular development process. The gender change agent established a supporting organizational framework of all stakeholders, and developed a 10-step approach including identification, selection, placing relevant sex and gender medicine-related issues in the curricular planning sessions, counseling of faculty members, and monitoring of the integration achieved. With this approach, quantitatively sex and gender medicine-related content was widely integrated throughout all teaching and learning formats and from early basic science to later clinical modules (94 lectures, 33 seminars, and 16 practical courses). Gender perspectives involve 5% of the learning objectives and represent an integral part of the assessment program. Qualitatively, the relevance of gender (sociocultural) differences was combined with sex (biological) differences in disease manifestation throughout the curriculum. The appointment of a change agent facilitates the development of systematic approaches that can be a key and serve as practice models to successfully integrate new overarching curricular perspectives and dimensions--in this case sex and gender medicine--into a new medical curriculum.

  3. An effective integrated learning programme in the first year of the medical course.

    Science.gov (United States)

    Vyas, R; Jacob, M; Faith, M; Isaac, B; Rabi, S; Sathishkumar, S; Selvakumar, D; Ganesh, A

    2008-01-01

    An integrated approach to teaching medical subjects is an effective educational strategy. Yet, this has not become popular in medical colleges in India. We describe an integrated learning programme to teach the gastrointestinal system in the first year of the medical course. The integrated learning programme was conducted for 3 years (2003-2005). It incorporated elements of problem-based learning, early clinical exposure, lectures and small group laboratory work. Student assessment was formative (for problem-based learning sessions) and summative (using problem-based learning and knowledge tests). Evaluation of the programme was based on feedback from the students and faculty members. Ninety-six per cent of the students obtained more than 60% marks in the problem-based learning test. The mean (SD) score in the knowledge test was 62 (0.89)%. The majority of students received satisfactory and more than satisfactory grades for their performance in the problem-based learning sessions. The feedback from faculty members and students was positive, which highlighted benefits such as integrated learning of the basic sciences, their application to clinical cases and active student learning. The challenges encountered included the higher input required from faculty members. Most of the faculty members and students recommended that the integrated programme should be continued and extended to other parts of the curriculum. An integrated learning programme is feasible within a conventional medical curriculum of an Indian medical college.

  4. Enabling Medical Device Interoperability for the Integrated Clinical Environment

    Science.gov (United States)

    2016-12-01

    Integration ” at Society of Critical Care Medicine Annual Congress, San Francisco, CA  January 21-22 2014 – Chaired Meetings for US TAG ISO TC 121 on...Award Number: W81XWH-12-C-0154 TITLE: “Enabling Medical Device Interoperability for the Integrated Clinical Environment” PRINCIPAL INVESTIGATOR...Julian M. Goldman, MD CONTRACTING ORGANIZATION: Massachusetts General Hospital Boston, MA 02114 REPORT DATE: December 2016 TYPE OF REPORT : Final

  5. Medical Device Integration Model Based on the Internet of Things

    Science.gov (United States)

    Hao, Aiyu; Wang, Ling

    2015-01-01

    At present, hospitals in our country have basically established the HIS system, which manages registration, treatment, and charge, among many others, of patients. During treatment, patients need to use medical devices repeatedly to acquire all sorts of inspection data. Currently, the output data of the medical devices are often manually input into information system, which is easy to get wrong or easy to cause mismatches between inspection reports and patients. For some small hospitals of which information construction is still relatively weak, the information generated by the devices is still presented in the form of paper reports. When doctors or patients want to have access to the data at a given time again, they can only look at the paper files. Data integration between medical devices has long been a difficult problem for the medical information system, because the data from medical devices are lack of mandatory unified global standards and have outstanding heterogeneity of devices. In order to protect their own interests, manufacturers use special protocols, etc., thus causing medical decices to still be the "lonely island" of hospital information system. Besides, unfocused application of the data will lead to failure to achieve a reasonable distribution of medical resources. With the deepening of IT construction in hospitals, medical information systems will be bound to develop towards mobile applications, intelligent analysis, and interconnection and interworking, on the premise that there is an effective medical device integration (MDI) technology. To this end, this paper presents a MDI model based on the Internet of Things (IoT). Through abstract classification, this model is able to extract the common characteristics of the devices, resolve the heterogeneous differences between them, and employ a unified protocol to integrate data between devices. And by the IoT technology, it realizes interconnection network of devices and conducts associate matching

  6. Medical approaches to gambling issues--I: The medical condition.

    Science.gov (United States)

    Miller, M M

    1996-09-01

    Gambling is a common human behavior. People who gamble encounter physicians. At times, gambling can produce adverse consequences for the player. Persistence of gambling despite adverse consequences can be called problem gambling. Roughly 1% of adults and 3% of adolescents exhibit signs of a medical disorder defined as pathological gambling. In many areas, including Wisconsin, gambling is increasing in legality, availability, and prevalence, and with it, pathological gambling is increasing in prevalence. This paper provides a descriptive review of gambling behaviors and the condition of pathological gambling, in the hope of increasing the awareness of practicing physicians, medical educators and researchers, and public policy makers, about what is known about these behaviors and the features of gambling illness that may present in a clinical setting. A companion paper focuses on the opportunities for constructive clinical activity by physicians regarding gambling problems.

  7. Mentoring by design: integrating medical professional competencies into bioengineering and medical physics graduate training.

    Science.gov (United States)

    Woods, Kendra V; Peek, Kathryn E; Richards-Kortum, Rebecca

    2014-12-01

    Many students in bioengineering and medical physics doctoral programs plan careers in translational research. However, while such students generally have strong quantitative abilities, they often lack experience with the culture, communication norms, and practice of bedside medicine. This may limit students' ability to function as members of multidisciplinary translational research teams. To improve students' preparation for careers in cancer translational research, we developed and implemented a mentoring program that is integrated with students' doctoral studies and aims to promote competencies in communication, biomedical ethics, teamwork, altruism, multiculturalism, and accountability. Throughout the program, patient-centered approaches and professional competencies are presented as foundational to optimal clinical care and integral to translational research. Mentoring is conducted by senior biomedical faculty and administrators and includes didactic teaching, online learning, laboratory mini-courses, clinical practicums, and multidisciplinary patient planning conferences (year 1); student development and facilitation of problem-based patient cases (year 2); and individualized mentoring based on research problems and progress toward degree completion (years 3-5). Each phase includes formative and summative evaluations. Nineteen students entered the program from 2009 through 2011. On periodic anonymous surveys, the most recent in September 2013, students indicated that the program substantially improved their knowledge of cancer biology, cancer medicine, and academic medicine; that the mentors were knowledgeable, good teachers, and dedicated to students; and that the program motivated them to become well-rounded scientists and scholars. We believe this program can be modified and disseminated to other graduate research and professional health care programs.

  8. Integrating Medical Simulation Into the Physician Assistant Physiology Curriculum.

    Science.gov (United States)

    Li, Lixin; Lopes, John; Zhou, Joseph Yi; Xu, Biao

    2016-12-01

    Medical simulation has recently been used in medical education, and evidence indicates that it is a valuable tool for teaching and evaluation. Very few studies have evaluated the integration of medical simulation in medical physiology education, particularly in PA programs. This study was designed to assess the value of integrating medical simulation into the PA physiology curriculum. Seventy-five students from the PA program at Central Michigan University participated in this study. Mannequin-based simulation was used to simulate a patient with hemorrhagic shock and congestive heart failure to demonstrate the Frank-Starling force and cardiac function curve. Before and after the medical simulation, students completed a questionnaire as a self-assessment. A knowledge test was also delivered after the simulation. Our study demonstrated a significant improvement in student confidence in understanding congestive heart failure, hemorrhagic shock, and the Frank-Starling curve after the simulation. Medical simulation may be an effective way to enhance basic science learning experiences for students and an ideal supplement to traditional, lecture-based teaching in PA education.

  9. Integration of Primary Care and Psychiatry: A New Paradigm for Medical Student Clerkships.

    Science.gov (United States)

    Wilkins, Kirsten M; Fenick, Ada M; Goldenberg, Matthew N; Ellis, Peter J; Barkil-Oteo, Andres; Rohrbaugh, Robert M

    2018-01-01

    Public health crises in primary care and psychiatry have prompted development of innovative, integrated care models, yet undergraduate medical education is not currently designed to prepare future physicians to work within such systems. To implement an integrated primary care-psychiatry clerkship for third-year medical students. Undergraduate medical education, amid institutional curriculum reform. Two hundred thirty-seven medical students participated in the clerkship in academic years 2015-2017. Educators in psychiatry, internal medicine, and pediatrics developed a 12-week integrated Biopsychosocial Approach to Health (BAH)/Primary Care-Psychiatry Clerkship. The clerkship provides students clinical experience in primary care, psychiatry, and integrated care settings, and a longitudinal, integrated didactic series covering key areas of interface between the two disciplines. Students reported satisfaction with the clerkship overall, rating it 3.9-4.3 on a 1-5 Likert scale, but many found its clinical curriculum and administrative organization disorienting. Students appreciated the conceptual rationale integrating primary care and psychiatry more in the classroom setting than in the clinical setting. While preliminary clerkship outcomes are promising, further optimization and evaluation of clinical and classroom curricula are ongoing. This novel educational paradigm is one model for preparing students for the integrated healthcare system of the twenty-first century.

  10. Clinical research and medical care: towards effective and complete integration.

    Science.gov (United States)

    Sacristán, José A

    2015-01-09

    Despite their close relationship, clinical research and medical care have become separated by clear boundaries. The purpose of clinical research is to generate generalizable knowledge useful for future patients, whereas medical care aims to promote the well-being of individual patients. The evolution towards patient-centered medicine and patient-oriented research, and the gradual standardization of medicine are contributing to closer ties between clinical research and medical practice. But the integration of both activities requires addressing important ethical and methodological challenges. From an ethical perspective, clinical research should evolve from a position of paternalistic beneficence to a situation in which the principle of non-maleficence and patient autonomy predominate. The progressive adoption of "patient-oriented informed consent", "patient equipoise", and "altruism-based research", and the application of risk-based ethical oversight, in which the level of regulatory scrutiny is adapted to the potential risk for patients, are crucial steps to achieve the integration between research and care. From a methodological standpoint, careful and systematic observations should have greater relevance in clinical research, and experiments should be embedded into usual clinical practice. Clinical research should focus on individuals through the development of patient-oriented research. In a complementary way, the integration of experiments into medical practice through the systematic application of "point of care research" could help to generate knowledge for the individuals and for the populations. The integration of clinical research and medical care will require researchers, clinicians, health care managers, and patients to reevaluate the way they understand both activities. The development of an integrated learning health care system will contribute to generating and applying clinically relevant medical knowledge, producing benefits for present and future

  11. Medical Student Attitudes toward Complementary, Alternative and Integrative Medicine

    Directory of Open Access Journals (Sweden)

    Ryan B. Abbott

    2011-01-01

    Full Text Available While the use of complementary, alternative and integrative medicine (CAIM is substantial, it continues to exist at the periphery of allopathic medicine. Understanding the attitudes of medical students toward CAIM will be useful in understanding future integration of CAIM and allopathic medicine. This study was conducted to develop and evaluate an instrument and assess medical students' attitudes toward CAIM. The Complementary, Alternative and Integrative Medicine Attitudes Questionnaire (CAIMAQ was developed by a panel of experts in CAIM, allopathic medicine, medical education and survey development. A total of 1770 CAIMAQ surveys (51% of US medical schools participated were obtained in a national sample of medical students in 2007. Factor analysis of the CAIMAQ revealed five distinct attitudinal domains: desirability of CAIM therapies, progressive patient/physician health care roles, mind-body-spirit connection, principles of allostasis and a holistic understanding of disease. The students held the most positive attitude for the “mind-body-spirit connection” and the least positive for the “desirability of CAIM therapies”. This study provided initial support for the reliability of the CAIMAQ. The survey results indicated that in general students responded more positively to the principles of CAIM than to CAIM treatment. A higher quality of CAIM-related medical education and expanded research into CAIM therapies would facilitate appropriate integration of CAIM into medical curricula. The most significant limitation of this study is a low response rate, and further work is required to assess more representative populations in order to determine whether the relationships found in this study are generalizable.

  12. Nurses' role in medical error recovery: an integrative review.

    Science.gov (United States)

    Gaffney, Theresa A; Hatcher, Barbara J; Milligan, Renee

    2016-04-01

    The aim of this study was to conduct an integrative review of the literature to fully understand nurses' role in medical error recovery. Despite focused efforts on error prevention, the prevalence of medical errors occurring in the health care system remains a concern. Patient harm can be reduced or prevented by adequate recovery processes that include identifying, interrupting and correcting medical errors in a timely fashion. Both medical error prevention and recovery are critical components in advancing patient safety, yet little is known about nurses' role in medical error recovery. An integrative review of the literature, guided by Whittmore and Knafl's (Journal of Advanced Nursing, 5, 2005, 546) five-step process, was conducted for the period between 2000-2015. A comprehensive search yielded twelve articles for this review. The level and quality of evidence of the included articles was rated using a five-level rating system and the Johns Hopkins Nursing Quality of Evidence Appraisal developed by ©The Johns Hopkins Hospital/The Johns Hopkins University. The medical error recovery rate varied across specialty nursing populations with nurses recovering, on average, as many as one error per shift to as few as one error per week. Nurses rely on knowing the patient, environment and plan of care to aid in medical error recovery. Nurses play a unique yet invisible role in identifying, interrupting and recovering medical errors. Individual and organisational factors influencing nurses' ability to recover medical errors remain unclear. Greater understanding of nurse characteristics and organisational factors that influence error recovery can foster the development of effective strategies to detect and correct medical errors and enable organisations to reduce negative outcomes. © 2016 John Wiley & Sons Ltd.

  13. 2. Gestaltdrama as an Integrative Psychotherapeutic Approach

    Directory of Open Access Journals (Sweden)

    Polínek Martin Dominik

    2016-03-01

    Full Text Available The following text is an overview study which defines the basic phenomena and effective factors of Gestalt drama and outlines some of the researches carried out in this area by the author during recent years. Gestalt drama is the name of a specific psychotherapeutic approach applied by the author in his practice, which combines Gestalt therapy with expressive approaches (especially with dramatherapy, theatrotherapy and fairytale-therapy. Linking Gestalt therapy and expressive techniques results in a specific psychotherapeutic approach whose versatility and holistic conception makes it suitable not only for psychotherapy but also for self-development of people with special needs, as it has the potential to meet the higher psychological needs even when the lower needs are not sufficiently saturated. The article further presents the interpretation of the partial results of research focusing on the analysis of integration performance where gestaltdrama techniques have been applied. These performances resulted from one-day dramatherapy workshops with clients suffering from mental retardation and with clients with behavioural disorders. This includes the analysis of differences between dramatical expression within the above target groups.

  14. Collaborating to integrate curriculum in primary care medical education: successes and challenges from three US medical schools.

    Science.gov (United States)

    Pipas, Catherine F; Peltier, Deborah A; Fall, Leslie H; Olson, Ardis L; Mahoney, John F; Skochelak, Susan E; Gjerde, Craig L

    2004-01-01

    Traditional medical school department-based clerkship structures can lead to redundancy and/or gaps in curriculum, inefficient administrative systems, and academic isolation for clerkship directors. This paper describes the approaches, successes, and challenges three institutions experienced when implementing an interdepartmental collaboration to create an integrated primary care clerkship experience. Each school combined family medicine, ambulatory pediatrics, and ambulatory medicine into contiguous clerkship blocks. In all institutions, each clerkship maintained certain distinct features while the integrated aspects contained longitudinal curriculum of certain primary care topics. Evaluations by students demonstrated favorable responses to the new content and integrated methods of teaching, as did results of the Association of American Medical Colleges graduation survey. Faculty at each institution reported that their multidisciplinary approach has stimulated important educational collaborations, many of which require an economy of scale not often achievable within a single clerkship. These included innovative evaluation/documentation efforts; centralization of administrative tasks; enhanced recruitment, retention, and development of community-based faculty; an increase in the active core group of local and national primary care leaders; and an increase in scholarly activities. The collaborations have not occurred without challenges, primarily in the need for identifying sustainable resources for these and future collaborative educational endeavors. The benefits involved in developing an integrated primary care experience include expansion of curriculum content and methods, as well as enhancement of collegial support and resources to community-based and academic faculty. These integrations do, however, bring added challenges, time, and costs to traditional independent clerkships.

  15. Closed-loop approach for situation awareness of medical devices and operating room infrastructure

    Directory of Open Access Journals (Sweden)

    Rockstroh Max

    2015-09-01

    Full Text Available In recent years, approaches for information and control integration in the digital operating room have emerged. A major step towards an intelligent operating room and a cooperative technical environment would be autonomous adaptation of medical devices and systems to the surgical workflow. The OR staff should be freed from information seeking and maintenance tasks. We propose a closed-loop concept integrating workflow monitoring, processing and (semi-automatic interaction to bridge the gap between OR integration of medical devices and workflow-related information management.

  16. Medical back belt with integrated neuromuscular electrical stimulation

    NARCIS (Netherlands)

    Bottenberg, E. (Eliza); Brinks, G.J. (Ger); Hesse, J. (Jenny)

    2014-01-01

    The medical back belt with integrated neuromuscular electrical stimulation is anorthopedic device, which has two main functions. The first function is to stimulate the backmuscles by using a neuromuscular electrical stimulation device that releases regular,electrical impulses. The second function of

  17. Integrating the Medical Home into the EHDI Process

    Science.gov (United States)

    Munoz, Karen F.; Nelson, Lauri; Bradham, Tamala S.; Hoffman, Jeff; Houston, K. Todd

    2011-01-01

    State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that examined 12 areas within state EHDI programs. Related to how the medical home is integrated into the EHDI process, 273 items were listed by 48 coordinators, and themes were identified…

  18. Using A Model-Based Systems Engineering Approach For Exploration Medical System Development

    Science.gov (United States)

    Hanson, A.; Mindock, J.; McGuire, K.; Reilly, J.; Cerro, J.; Othon, W.; Rubin, D.; Urbina, M.; Canga, M.

    2017-01-01

    NASA's Human Research Program's Exploration Medical Capabilities (ExMC) element is defining the medical system needs for exploration class missions. ExMC's Systems Engineering (SE) team will play a critical role in successful design and implementation of the medical system into exploration vehicles. The team's mission is to "Define, develop, validate, and manage the technical system design needed to implement exploration medical capabilities for Mars and test the design in a progression of proving grounds." Development of the medical system is being conducted in parallel with exploration mission architecture and vehicle design development. Successful implementation of the medical system in this environment will require a robust systems engineering approach to enable technical communication across communities to create a common mental model of the emergent engineering and medical systems. Model-Based Systems Engineering (MBSE) improves shared understanding of system needs and constraints between stakeholders and offers a common language for analysis. The ExMC SE team is using MBSE techniques to define operational needs, decompose requirements and architecture, and identify medical capabilities needed to support human exploration. Systems Modeling Language (SysML) is the specific language the SE team is utilizing, within an MBSE approach, to model the medical system functional needs, requirements, and architecture. Modeling methods are being developed through the practice of MBSE within the team, and tools are being selected to support meta-data exchange as integration points to other system models are identified. Use of MBSE is supporting the development of relationships across disciplines and NASA Centers to build trust and enable teamwork, enhance visibility of team goals, foster a culture of unbiased learning and serving, and be responsive to customer needs. The MBSE approach to medical system design offers a paradigm shift toward greater integration between

  19. Evaluating Pain Education Programs: An Integrated Approach

    Directory of Open Access Journals (Sweden)

    Adam Dubrowski

    2011-01-01

    Full Text Available Evaluation of educational programs and assessment of learning are essential to maintain high-standard health science education, which includes pain education. Current models of program evaluations applied to the education of the health professions, such as the Kirkpatrick model, are mainly outcome based. More recently, efforts have been made to examine other process-based models such as the Context Input Process Product model. The present article proposes an approach that integrates both outcome- and process-based models with models of clinical performance assessment to provide a deeper understanding of a program function. Because assessment instruments are a critical part of program evaluation, it is suggested that standardization and rigour should be used in their selection, development and adaptation. The present article suggests an alternative to currently used models in pain education evaluation.

  20. MODELS OF TECHNOLOGY ADOPTION: AN INTEGRATIVE APPROACH

    Directory of Open Access Journals (Sweden)

    Andrei OGREZEANU

    2015-06-01

    Full Text Available The interdisciplinary study of information technology adoption has developed rapidly over the last 30 years. Various theoretical models have been developed and applied such as: the Technology Acceptance Model (TAM, Innovation Diffusion Theory (IDT, Theory of Planned Behavior (TPB, etc. The result of these many years of research is thousands of contributions to the field, which, however, remain highly fragmented. This paper develops a theoretical model of technology adoption by integrating major theories in the field: primarily IDT, TAM, and TPB. To do so while avoiding mess, an approach that goes back to basics in independent variable type’s development is proposed; emphasizing: 1 the logic of classification, and 2 psychological mechanisms behind variable types. Once developed these types are then populated with variables originating in empirical research. Conclusions are developed on which types are underpopulated and present potential for future research. I end with a set of methodological recommendations for future application of the model.

  1. Permutation statistical methods an integrated approach

    CERN Document Server

    Berry, Kenneth J; Johnston, Janis E

    2016-01-01

    This research monograph provides a synthesis of a number of statistical tests and measures, which, at first consideration, appear disjoint and unrelated. Numerous comparisons of permutation and classical statistical methods are presented, and the two methods are compared via probability values and, where appropriate, measures of effect size. Permutation statistical methods, compared to classical statistical methods, do not rely on theoretical distributions, avoid the usual assumptions of normality and homogeneity of variance, and depend only on the data at hand. This text takes a unique approach to explaining statistics by integrating a large variety of statistical methods, and establishing the rigor of a topic that to many may seem to be a nascent field in statistics. This topic is new in that it took modern computing power to make permutation methods available to people working in the mainstream of research. This research monograph addresses a statistically-informed audience, and can also easily serve as a ...

  2. Thermodynamics and statistical mechanics an integrated approach

    CERN Document Server

    Shell, M Scott

    2015-01-01

    Learn classical thermodynamics alongside statistical mechanics with this fresh approach to the subjects. Molecular and macroscopic principles are explained in an integrated, side-by-side manner to give students a deep, intuitive understanding of thermodynamics and equip them to tackle future research topics that focus on the nanoscale. Entropy is introduced from the get-go, providing a clear explanation of how the classical laws connect to the molecular principles, and closing the gap between the atomic world and thermodynamics. Notation is streamlined throughout, with a focus on general concepts and simple models, for building basic physical intuition and gaining confidence in problem analysis and model development. Well over 400 guided end-of-chapter problems are included, addressing conceptual, fundamental, and applied skill sets. Numerous worked examples are also provided together with handy shaded boxes to emphasize key concepts, making this the complete teaching package for students in chemical engineer...

  3. Systematic Approach to Better Understanding Integration Costs

    Energy Technology Data Exchange (ETDEWEB)

    Stark, Gregory B. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-09-01

    This research presents a systematic approach to evaluating the costs of integrating new generation and operational procedures into an existing power system, and the methodology is independent of the type of change or nature of the generation. The work was commissioned by the U.S. Department of Energy and performed by the National Renewable Energy Laboratory to investigate three integration cost-related questions: (1) How does the addition of new generation affect a system's operational costs, (2) How do generation mix and operating parameters and procedures affect costs, and (3) How does the amount of variable generation (non-dispatchable wind and solar) impact the accuracy of natural gas orders? A detailed operational analysis was performed for seven sets of experiments: variable generation, large conventional generation, generation mix, gas prices, fast-start generation, self-scheduling, and gas supply constraints. For each experiment, four components of integration costs were examined: cycling costs, non-cycling VO&M costs, fuel costs, and reserves provisioning costs. The investigation was conducted with PLEXOS production cost modeling software utilizing an updated version of the Institute of Electrical and Electronics Engineers 118-bus test system overlaid with projected operating loads from the Western Electricity Coordinating Council for the Sacramento Municipal Utility District, Puget Sound Energy, and Public Service Colorado in the year 2020. The test system was selected in consultation with an industry-based technical review committee to be a reasonable approximation of an interconnection yet small enough to allow the research team to investigate a large number of scenarios and sensitivity combinations. The research should prove useful to market designers, regulators, utilities, and others who want to better understand how system changes can affect production costs.

  4. An Architectural Approach for Building Medical Ontologies

    Directory of Open Access Journals (Sweden)

    Mircea Adrian FOCŞA

    2016-07-01

    Full Text Available Starting from a use case scenario related to the Electronic Medical Record (EMR information retrieval, this paper proposes several design principles for an ontology-based EMR system, which will allow the physician to perform a semantic search about a specific body structure or zone/space (affected, explored or treated. The research starts from analyzing the information requirements of the family doctors related to the medical history of their patients. By interviewing a group of family doctors, a set of common questions have been identified and modeled as one generic question. The key terms from this generic question then became the building blocks of an ontology, which was further built incrementally and constantly adjusted depending on the query response (design pattern by querying. Elements from other terminologies/ontologies have been reused thus facilitating interoperability with similar constructions. As a result of this research, we tested and proposed for adoption several basic modeling principles for medical ontologies, among them, the particularities of part-whole relations for body regions/spaces and anatomical components, the requirements for propagation of the medical activities from one class to an upper or subsequent class. These modeling principles have a good degree of generality and could be taken into consideration for building any medical ontology.

  5. Path integral for spin: A new approach

    International Nuclear Information System (INIS)

    Aliev, T.M.; Fainberg, V.Ya.; Pak, N.K.

    1994-01-01

    The path integral representation for the propagator of a Dirac particle in an external electromagnetic field is derived using the functional derivative formalism with the help of Weyl symbol representation for the Grassmann vector part of the variables. The proposed method simplifies the proof of the path integral representation starting from the equation for the Green function significantly and automatically leads to a precise and unambiguous set of boundary conditions for the anticommuting variables and puts strong restrictions on the choice of the gauge conditions. The same problem is reconsidered using the Polyakov and Batalin-Fradkin-Vilkovisky methods together with the Weyl symbol method and it is shown to yield the same PIR. It is shown that in the last case, the non-trivial first class constraints algebra for a Dirac particle plays an important role in the derivation, and this algebra is the limiting case of the superconformal algebra for a Ramond open string when the width goes to zero. That the approach proposed here can be applied to any point-like particle is illustrated in the propagator for the nonrelativistic Pauli spinning particle in an external electromagnetic field. ((orig.))

  6. Quantum gravitation. The Feynman path integral approach

    International Nuclear Information System (INIS)

    Hamber, Herbert W.

    2009-01-01

    The book covers the theory of Quantum Gravitation from the point of view of Feynman path integrals. These provide a manifestly covariant approach in which fundamental quantum aspects of the theory such as radiative corrections and the renormalization group can be systematically and consistently addressed. The path integral method is suitable for both perturbative as well as non-perturbative studies, and is known to already provide a framework of choice for the theoretical investigation of non-abelian gauge theories, the basis for three of the four known fundamental forces in nature. The book thus provides a coherent outline of the present status of the theory gravity based on Feynman's formulation, with an emphasis on quantitative results. Topics are organized in such a way that the correspondence to similar methods and results in modern gauge theories becomes apparent. Covariant perturbation theory are developed using the full machinery of Feynman rules, gauge fixing, background methods and ghosts. The renormalization group for gravity and the existence of non-trivial ultraviolet fixed points are investigated, stressing a close correspondence with well understood statistical field theory models. Later the lattice formulation of gravity is presented as an essential tool towards an understanding of key features of the non-perturbative vacuum. The book ends with a discussion of contemporary issues in quantum cosmology such as scale dependent gravitational constants and quantum effects in the early universe. (orig.)

  7. Semantic integration of medication data into the EHOP Clinical Data Warehouse.

    Science.gov (United States)

    Delamarre, Denis; Bouzille, Guillaume; Dalleau, Kevin; Courtel, Denis; Cuggia, Marc

    2015-01-01

    Reusing medication data is crucial for many medical research domains. Semantic integration of such data in clinical data warehouse (CDW) is quite challenging. Our objective was to develop a reliable and scalable method for integrating prescription data into EHOP (a French CDW). PN13/PHAST was used as the semantic interoperability standard during the ETL process, and to store the prescriptions as documents in the CDW. Theriaque was used as a drug knowledge database (DKDB), to annotate the prescription dataset with the finest granularity, and to provide semantic capabilities to the EHOP query workbench. the system was evaluated on a clinical data set. Depending on the use case, the precision ranged from 52% to 100%, Recall was always 100%. interoperability standards and DKDB, document approach, and the finest granularity approach are the key factors for successful drug data integration in CDW.

  8. Undergraduate medical student's perception about an integrated method of teaching at a medical school in Oman

    Directory of Open Access Journals (Sweden)

    Harshal Sabane

    2015-01-01

    Full Text Available Objective In recent years, there has been a gradual but definitive shift in medical schools all over the globe to promote a more integrated way of teaching. Integration of medical disciplines promotes a holistic understanding of the medical curriculum in the students. This helps them better understand and appreciate the importance and role of each medical subject. Method The study was conducted among the 5th year Pre-clinical students. Questionnaire consisted of 4 questions on the level of integration, 5 questions on various aspects of the assessment and some questions which tested the level of awareness of the integrated method. Result Out of a total of 72 students present on the day of data collection, 65 participated in the study giving a response rate of 90.27 %. After primary data cleansing 4 questionnaires had to be omitted. Most of the students opined as “good” or “very good” for the questions on integration and its attributes. Only 27 (44 % were aware of integrated curriculum being taught in other medical schools in the gulf. Similar findings were observed regarding assessment related questions. Reduction in the number of block exams is unpopular among the students and only 6% have agreed for 3, 4, or 5 non-summative block assessments. Opinion regarding the help of integrated teaching in IFOM based OMSB entrance examination was mixed with a greater variance in the responses. 43% students have indicated that they would like to spend more time with PDCI. Conclusion The students of our institution seem to have a favourable opinion regarding the integrated system of teaching. The satisfaction with the conduct of examinations and its related variables is found to be high. A reduction in the number of block exams however is unpopular among the target group and they would appreciate a greater time allocation for subjects of PDCI and Pharmacology.

  9. Impact of a New Integrated Medicine Program on Students' Approaches to Learning

    Science.gov (United States)

    Balasooriya, Chinthaka Damith; Hughes, Christopher; Toohey, Susan

    2009-01-01

    This paper presents the results of a study on the impact of a new integrated medical educational design on students' approaches to learning. Although the new program was based on curriculum features identified in the research literature as likely to promote deeper approaches to learning, the results revealed a more complex response from students.…

  10. Medication errors--new approaches to prevention.

    Science.gov (United States)

    Merry, Alan F; Anderson, Brian J

    2011-07-01

    Medication errors in pediatric anesthesia represent an important risk to children. Concerted action to reduce harm from this cause is overdue. An understanding of the genesis of avoidable adverse drug events may facilitate the development of effective countermeasures to the events or their effects. Errors include those involving the automatic system of cognition and those involving the reflective system. Errors and violations are distinct, but violations often predispose to error. The system of medication administration is complex, and many aspects of it are conducive to error. Evidence-based practices to reduce the risk of medication error in general include those encompassed by the following recommendations: systematic countermeasures should be used to decrease the number of drug administration errors in anesthesia; the label on any drug ampoule or syringe should be read carefully before a drug is drawn up or injected; the legibility and contents of labels on ampoules and syringes should be optimized according to agreed standards; syringes should always be labeled; formal organization of drug drawers and workspaces should be used; labels should be checked with a second person or a device before a drug is drawn up or administered. Dosage errors are particularly common in pediatric patients. Causes that should be addressed include a lack of pediatric formulations and/or presentations of medication that necessitates dilution before administration or the use of intravenous formulations for oral administration in children, a frequent failure to obtain accurate weights for patients and a paucity of pharmacokinetic and pharmacodynamic data. Technological innovations, including the use of bar codes and various cognitive aids, may facilitate compliance with these recommendations. Improved medication safety requires a system-wide strategy standardized at least to the level of the institution; it is the responsibility of institutional leadership to introduce such strategies

  11. The Integrated Medical Model - Optimizing In-flight Space Medical Systems to Reduce Crew Health Risk and Mission Impacts

    Science.gov (United States)

    Kerstman, Eric; Walton, Marlei; Minard, Charles; Saile, Lynn; Myers, Jerry; Butler, Doug; Lyengar, Sriram; Fitts, Mary; Johnson-Throop, Kathy

    2009-01-01

    The Integrated Medical Model (IMM) is a decision support tool used by medical system planners and designers as they prepare for exploration planning activities of the Constellation program (CxP). IMM provides an evidence-based approach to help optimize the allocation of in-flight medical resources for a specified level of risk within spacecraft operational constraints. Eighty medical conditions and associated resources are represented in IMM. Nine conditions are due to Space Adaptation Syndrome. The IMM helps answer fundamental medical mission planning questions such as What medical conditions can be expected? What type and quantity of medical resources are most likely to be used?", and "What is the probability of crew death or evacuation due to medical events?" For a specified mission and crew profile, the IMM effectively characterizes the sequence of events that could potentially occur should a medical condition happen. The mathematical relationships among mission and crew attributes, medical conditions and incidence data, in-flight medical resources, potential clinical and crew health end states are established to generate end state probabilities. A Monte Carlo computational method is used to determine the probable outcomes and requires up to 25,000 mission trials to reach convergence. For each mission trial, the pharmaceuticals and supplies required to diagnose and treat prevalent medical conditions are tracked and decremented. The uncertainty of patient response to treatment is bounded via a best-case, worst-case, untreated case algorithm. A Crew Health Index (CHI) metric, developed to account for functional impairment due to a medical condition, provides a quantified measure of risk and enables risk comparisons across mission scenarios. The use of historical in-flight medical data, terrestrial surrogate data as appropriate, and space medicine subject matter expertise has enabled the development of a probabilistic, stochastic decision support tool capable of

  12. MEDICAL BRAIN DRAIN - A THEORETICAL APPROACH

    Directory of Open Access Journals (Sweden)

    Boncea Irina

    2013-07-01

    Full Text Available Medical brain drain is defined as the migration of health personnel from developing countries to developed countries and between industrialized nations in search for better opportunities. This phenomenon became a global growing concern due to its impact on both the donor and the destination countries. This article aims to present the main theoretical contributions starting from 1950 until today and the historical evolution, in the attempt of correlating the particular case of medical brain drain with the theory and evolution of the brain drain in general. This article raises questions and offers answers, identifies the main issues and looks for possible solutions in order to reduce the emigration of medical doctors. Factors of influence include push (low level of income, poor working conditions, the absence of job openings and social recognition, oppressive political climate and pull (better remuneration and working conditions, prospects for career development, job satisfaction, security factors. Developing countries are confronting with the loss of their most valuable intellectuals and the investment in their education, at the benefit of developed nations. An ethical debate arises as the disparities between countries increases, industrialized nations filling in the gaps in health systems with professionals from countries already facing shortages. However, recent literature emphasizes the possibility of a “beneficial brain drain” through education incentives offered by the emigration prospects. Other sources of “brain gain” for donor country are the remittances, the scientific networks and return migration. Measures to stem the medical brain drain involve the common effort and collaboration between developing and developed countries and international organizations. Measures adopted by donor countries include higher salaries, better working conditions, security, career opportunities, incentives to stimulate return migration. Destination

  13. Differences in the Students' Perceptions on the Teaching of Neuroanatomy in a Medical Curriculum Organized by Disciplines and an Integrated Medical Curriculum.

    Science.gov (United States)

    Arantes, Mavilde; Barbosa, Joselina; Ferreira, Maria Amélia

    2017-01-31

    On the subject of curriculum reform, most European medical schools are moving away from an educational approach consisting of discipline-based courses to an integrated curriculum. The aim of this study was to compare, in the Faculty of Medicine of the University of Porto, Portugal, the teaching of neuroanatomy in a medical curriculum organized by disciplines and in an integrated medical curriculum. Two hundred sixty one students who completed the Curricular Unit with a discipline-based approach (Neuroanatomy) and 202 students who completed it with an integrated approach (Morphophysiology of the Nervous System) were asked to complete a questionnaire on their perceptions about the Curricular Unit. Our study showed that students of the Curricular Unit with a discipline-based approach had higher grades and evaluated it higher than students who followed the integrated approach. However, it also showed that students' grades had a significant effect on the evaluation of the curricular unit, with students with higher grades evaluating higher than students with lower grades. Besides, the majority of the students of the Curricular Unit with an integrated approach appreciated this curriculum model and highlighted as a positive point the successful integration of contents covered in the three components of the curricular unit. The curriculum reform led to the integration of neuroanatomy with other disciplines and resulted in a reduction of the teaching hours, a redefinition of the syllabus contents and the students' learning objectives, the introduction of new educational methods and changes in the evaluation system. Our study could not prove conclusively the supremacy of one pedagogic approach to neuroanatomy over the other. Future initiatives to explore different pedagogical models in medical education are needed and should be of major concern to the medical faculty.

  14. Process-outcome interrelationship and standard setting in medical education: the need for a comprehensive approach.

    Science.gov (United States)

    Christensen, Leif; Karle, Hans; Nystrup, Jørgen

    2007-09-01

    An outcome-based approach to medical education compared to a process/content orientation is currently being discussed intensively. In this article, the process and outcome interrelationship in medical education is discussed, with specific emphasis on the relation to the definition of standards in basic medical education. Perceptions of outcome have always been an integrated element of curricular planning. The present debate underlines the need for stronger focus on learning objectives and outcome assessment in many medical schools around the world. The need to maintain an integrated approach of process/content and outcome is underlined in this paper. A worry is expressed about the taxonomy of learning in pure outcome-based medical education, in which student assessment can be a major determinant for the learning process, leaving the control of the medical curriculum to medical examiners. Moreover, curricula which favour reductionism by stating everything in terms of instrumental outcomes or competences, do face a risk of lowering quality and do become a prey for political interference. Standards based on outcome alone rise unclarified problems in relationship to licensure requirements of medical doctors. It is argued that the alleged dichotomy between process/content and outcome seems artificial, and that formulation of standards in medical education must follow a comprehensive line in curricular planning.

  15. National electronic medical records integration on cloud computing system.

    Science.gov (United States)

    Mirza, Hebah; El-Masri, Samir

    2013-01-01

    Few Healthcare providers have an advanced level of Electronic Medical Record (EMR) adoption. Others have a low level and most have no EMR at all. Cloud computing technology is a new emerging technology that has been used in other industry and showed a great success. Despite the great features of Cloud computing, they haven't been utilized fairly yet in healthcare industry. This study presents an innovative Healthcare Cloud Computing system for Integrating Electronic Health Record (EHR). The proposed Cloud system applies the Cloud Computing technology on EHR system, to present a comprehensive EHR integrated environment.

  16. An integrative approach to understanding bird origins.

    Science.gov (United States)

    Xu, Xing; Zhou, Zhonghe; Dudley, Robert; Mackem, Susan; Chuong, Cheng-Ming; Erickson, Gregory M; Varricchio, David J

    2014-12-12

    Recent discoveries of spectacular dinosaur fossils overwhelmingly support the hypothesis that birds are descended from maniraptoran theropod dinosaurs, and furthermore, demonstrate that distinctive bird characteristics such as feathers, flight, endothermic physiology, unique strategies for reproduction and growth, and a novel pulmonary system originated among Mesozoic terrestrial dinosaurs. The transition from ground-living to flight-capable theropod dinosaurs now probably represents one of the best-documented major evolutionary transitions in life history. Recent studies in developmental biology and other disciplines provide additional insights into how bird characteristics originated and evolved. The iconic features of extant birds for the most part evolved in a gradual and stepwise fashion throughout archosaur evolution. However, new data also highlight occasional bursts of morphological novelty at certain stages particularly close to the origin of birds and an unavoidable complex, mosaic evolutionary distribution of major bird characteristics on the theropod tree. Research into bird origins provides a premier example of how paleontological and neontological data can interact to reveal the complexity of major innovations, to answer key evolutionary questions, and to lead to new research directions. A better understanding of bird origins requires multifaceted and integrative approaches, yet fossils necessarily provide the final test of any evolutionary model. Copyright © 2014, American Association for the Advancement of Science.

  17. An integrated approach of analytical chemistry

    Directory of Open Access Journals (Sweden)

    Guardia Miguel de la

    1999-01-01

    Full Text Available The tremendous development of physical methods of analysis offers an impressive number of tools to simultaneously determine a large number of elements and compounds at very low concentration levels. Todays Analytical Chemistry provides appropriate media to solve technical problems and to obtain correct information about chemical systems in order to take the most appropriate decisions for problem solving. In recent years the development of new strategies for sampling, sample treatment and data exploitation through the research on field sampling, microwaveassisted procedures and chemometrics, additionally the revolution of the analytical methodology provided by the development of flow analysis concepts and process analysis strategies offer a link between modern instrumentation and social or technological problems. The integrated approach of Analytical Chemistry requires correctly incorporating the developments in all of the fields of both, basic chemistry, instrumentation and information theory, in a scheme which considers all aspects of data obtention and interpretation taking also into consideration the side effects of chemical measurements. In this paper, new ideas and tools for trace analysis, speciation, surface analysis, data acquisition and data treatment, automation and decontamination, are presented in the frame of Analytical Chemistry as a problem solving strategy focused on the chemical composition of systems and on the specific figures of merit of the analytical measurements, like accuracy, precision, sensitivity, selectivity but also speed and cost. Technological and industrial, but also environmental, health and social problems, have been considered as challenges for which solution the chemist should select the most appropriate tool and to develop an appropriate strategy.

  18. Nuclear power programme planning: An integrated approach

    International Nuclear Information System (INIS)

    2001-12-01

    The International Atomic Energy Agency (IAEA) has published material on different policy considerations in the introduction of nuclear power, primarily addressed to top level decision makers in government and industry in Member States. Several Member States and experts recommended to the IAEA to address the aspects of an integrated approach to nuclear power programme planning and to serve as guidance to those countries wishing to embark on a nuclear power programme. As a follow-up, the present publication is primarily intended to serve as guidance for executives and managers in Member States in planning for possible introduction of nuclear power plants in their electricity generating systems. Nuclear power programme planning, as dealt with in this publication, includes all activities that need to be carried out up to a well-founded decision to proceed with a project feasibility study. Project implementation beyond this decision is not in the scope of this publication. Although it is possible to use nuclear energy as a heat source for industrial processes, desalination and other heat applications, it is assumed in this publication that the planning is aimed towards nuclear power for electricity generation. Much of the information given would, however, also be relevant for planning of nuclear reactors for heat production. The publication was prepared within the framework of the IAEA programme on nuclear power planning, implementation and performance as a joint activity of the Nuclear Power Engineering Section and the Planning and Economic Studies Section (Division of Nuclear Power)

  19. The Integrated Medical Model: A Probabilistic Simulation Model for Predicting In-Flight Medical Risks

    Science.gov (United States)

    Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G.

    2015-01-01

    The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

  20. The Integrated Medical Model: A Probabilistic Simulation Model Predicting In-Flight Medical Risks

    Science.gov (United States)

    Keenan, Alexandra; Young, Millennia; Saile, Lynn; Boley, Lynn; Walton, Marlei; Kerstman, Eric; Shah, Ronak; Goodenow, Debra A.; Myers, Jerry G., Jr.

    2015-01-01

    The Integrated Medical Model (IMM) is a probabilistic model that uses simulation to predict mission medical risk. Given a specific mission and crew scenario, medical events are simulated using Monte Carlo methodology to provide estimates of resource utilization, probability of evacuation, probability of loss of crew, and the amount of mission time lost due to illness. Mission and crew scenarios are defined by mission length, extravehicular activity (EVA) schedule, and crew characteristics including: sex, coronary artery calcium score, contacts, dental crowns, history of abdominal surgery, and EVA eligibility. The Integrated Medical Evidence Database (iMED) houses the model inputs for one hundred medical conditions using in-flight, analog, and terrestrial medical data. Inputs include incidence, event durations, resource utilization, and crew functional impairment. Severity of conditions is addressed by defining statistical distributions on the dichotomized best and worst-case scenarios for each condition. The outcome distributions for conditions are bounded by the treatment extremes of the fully treated scenario in which all required resources are available and the untreated scenario in which no required resources are available. Upon occurrence of a simulated medical event, treatment availability is assessed, and outcomes are generated depending on the status of the affected crewmember at the time of onset, including any pre-existing functional impairments or ongoing treatment of concurrent conditions. The main IMM outcomes, including probability of evacuation and loss of crew life, time lost due to medical events, and resource utilization, are useful in informing mission planning decisions. To date, the IMM has been used to assess mission-specific risks with and without certain crewmember characteristics, to determine the impact of eliminating certain resources from the mission medical kit, and to design medical kits that maximally benefit crew health while meeting

  1. A random approach to the Lebesgue integral

    Science.gov (United States)

    Grahl, Jack

    2008-04-01

    We construct an integral of a measurable real function using randomly chosen Riemann sums and show that it converges in probability to the Lebesgue integral where this exists. We then prove some conditions for the almost sure convergence of this integral.

  2. A structured approach to medical comanagement of surgical patients

    Directory of Open Access Journals (Sweden)

    Eric Siegal

    2012-12-01

    Full Text Available Comanagement is defined as shared responsibility, authority and accountability for the management of a hospitalized patient, and represents a fundamentally different model from traditional medical consultation. Medical comanagement has rapidly proliferated and is now a dominant model of care in American hospitals. Comanagement is most effective when patients are appropriately selected, processes are predetermined and systems are implemented to ensure rigorous and continuous improvement. This article provides a structured approach for conceptualizing and implementing medical comanagement.

  3. Towards an integrated approach in supporting microbiological food safety decisions

    DEFF Research Database (Denmark)

    Havelaar, A.H.; Braunig, J.; Christiansen, K.

    2007-01-01

    an integrated scientific approach combining veterinary and medical epidemiology, risk assessment for the farm-to-fork food chain as well as agricultural and health economy. Scientific advice is relevant in all stages of the policy cycle: to assess the magnitude of the food safety problem, to define...... the priorities for action, to establish the causes for the problem, to choose between different control options, to define targets along the food chain and to measure success.......Decisions on food safety involve consideration of a wide range of concerns including the public health impact of foodborne illness, the economic importance of the agricultural sector and the food industry, and the effectiveness and efficiency of interventions. To support such decisions, we propose...

  4. An Integrated Computer-Aided Approach for Environmental Studies

    DEFF Research Database (Denmark)

    Gani, Rafiqul; Chen, Fei; Jaksland, Cecilia

    1997-01-01

    A general framework for an integrated computer-aided approach to solve process design, control, and environmental problems simultaneously is presented. Physicochemical properties and their relationships to the molecular structure play an important role in the proposed integrated approach. The scope...... and applicability of the integrated approach is highlighted through examples involving estimation of properties and environmental pollution prevention. The importance of mixture effects on some environmentally important properties is also demonstrated....

  5. CANDU plant life management - An integrated approach

    International Nuclear Information System (INIS)

    Charlebois, P.; Hart, R.S.; Hopkins, J.R.

    1998-01-01

    Commercial versions of CANDU reactors were put into service starting more than 25 years ago. The first unit of Ontario Hydro's Pickering A station was put into service in 1971, and Bruce A in 1977. Most CANDU reactors, however, are only now approaching their mid-life of 15 to 20 years of operation. In particular, the first series of CANDU 6 plants which entered service in the early 1980's were designed for a 30 year life and are now approaching mid life. The current CANDU 6 design is based on a 40 year life as a result of advancement in design and materials through research and development. In order to assure safe and economic operation of these reactors, a comprehensive CANDU Plant Life Management (PLIM) program is being developed from the knowledge gained during the operation of Ontario Hydro's Pickering, Bruce, and Darlington stations, worldwide information from CANDU 6 stations, CANDU research and development programs, and other national and international sources. This integration began its first phase in 1994, with the identification of most of the critical systems structures and components in these stations, and a preliminary assessment of degradation and mechanisms that could affect their fitness for service for their planned life. Most of these preliminary assessments are now complete, together with the production of the first iteration of Life Management Plans for several of the systems and components. The Generic CANDU 6 PLIM program is now reaching its maturity, with formal processes to systematically identify and evaluate the major CSSCs in the station, and a plan to ensure that the plant surveillance, operation, and maintenance programs monitor and control component degradation well within the original design specifications essential for the plant life attainment. A Technology Watch program is being established to ensure that degradation mechanisms which could impact on plant life are promptly investigated and mitigating programs established. The

  6. A systematic approach to the reporting of medically relevant findings from whole genome sequencing

    OpenAIRE

    McLaughlin, Heather M; Ceyhan-Birsoy, Ozge; Christensen, Kurt D; Kohane, Isaac S; Krier, Joel; Lane, William J; Lautenbach, Denise; Lebo, Matthew S; Machini, Kalotina; MacRae, Calum A; Azzariti, Danielle R; Murray, Michael F; Seidman, Christine E; Vassy, Jason L; Green, Robert C

    2014-01-01

    Background: The MedSeq Project is a randomized clinical trial developing approaches to assess the impact of integrating genome sequencing into clinical medicine. To facilitate the return of results of potential medical relevance to physicians and patients participating in the MedSeq Project, we sought to develop a reporting approach for the effective communication of such findings. Methods: Genome sequencing was performed on the Illumina HiSeq platform. Variants were filtered, interpreted, an...

  7. Medical device integration: CIOs must bridge the digital divide between devices and electronic medical records.

    Science.gov (United States)

    Raths, David

    2009-02-01

    To get funding approved for medical device integration, ClOs suggest focusing on specific patient safety or staff efficiency pain points. Organizations that make clinical engineering part of their IT team report fewer chain-of-command issues. It also helps IT people understand the clinical goals because the engineering people have been working closely with clinicians for years. A new organization has formed to work on collaboration between clinical engineers and IT professionals. For more information, go to www.ceitcollaboration.org. ECRI Institute has written a guide to handling the convergence of medical technology and hospital networks. Its "Medical Technology for the IT Professional: An Essential Guide for Working in Today's Healthcare Setting" also details how IT professionals can assist hospital technology planning and acquisition, and provide ongoing support for IT-based medical technologies. For more information, visit www.ecri.org/ITresource.

  8. The integration of Information and Communication Technology into medical practice.

    Science.gov (United States)

    Lupiáñez-Villanueva, Francisco; Hardey, Michael; Torrent, Joan; Ficapal, Pilar

    2010-07-01

    To identify doctors' utilization of ICT; to develop and characterise a typology of doctors' utilization of ICT and to identify factors that can enhance or inhibit the use of these technologies within medical practice. An online survey of the 16,531 members of the Physicians Association of Barcelona who had a registered email account in 2006 was carried out. Factor analysis, cluster analysis and binomial logit model were undertaken. Multivariate statistics analysis of the 2199 responses obtained revealed two profiles of adoption of ICT. The first profile (38.61% of respondents) represents those doctors who place high emphasis on ICT within their practice. This group is thus referred to as 'integrated doctors'. The second profile (61.39% of respondents) represents those doctors who make less use of ICT so are consequently labelled 'non-integrated doctors'. From the statistical modelling, it was observed that an emphasis on international information; emphasis on ICT for research and medical practice; emphasis on information systems to consult and prescribe; undertaking teaching/research activities; a belief that the use of the Internet improved communication with patients and practice in both public and private health organizations play a positive and significant role in the probability of being an 'integrated doctor'. The integration of ICT within medical practice cannot be adequately understood and appreciated without examining how doctors are making use of ICT within their own practice, organizational contexts and the opportunities and constraints afforded by institutional, professional and patient expectations and demands. 2010 Elsevier Ireland Ltd. All rights reserved.

  9. Integrative and Interdisciplinary Approaches to Leadership Development.

    Science.gov (United States)

    Owen, Julie E

    2015-01-01

    Integrating diverse conceptions of leadership across different disciplines, perspectives, and epistemologies is imperative if leaders are to operate in a global and networked world. Interdisciplinary and integrative leadership courses and digital learning communities are featured examples. © 2015 Wiley Periodicals, Inc., A Wiley Company.

  10. Decomposition approaches to integration without a measure

    Czech Academy of Sciences Publication Activity Database

    Greco, S.; Mesiar, Radko; Rindone, F.; Sipeky, L.

    2016-01-01

    Roč. 287, č. 1 (2016), s. 37-47 ISSN 0165-0114 Institutional support: RVO:67985556 Keywords : Choquet integral * Decision making * Decomposition integral Subject RIV: BA - General Mathematics Impact factor: 2.718, year: 2016 http://library.utia.cas.cz/separaty/2016/E/mesiar-0457408.pdf

  11. [Research on medical instrument information integration technology based on IHE PCD].

    Science.gov (United States)

    Zheng, Jianli; Liao, Yun; Yang, Yongyong

    2014-06-01

    Integrating medical instruments with medical information systems becomes more and more important in healthcare industry. To make medical instruments without standard communication interface possess the capability of interoperating and sharing information with medical information systems, we developed a medical instrument integration gateway based on Integrating the Healthcare Enterprise Patient Care Device (IHE PCD) integration profiles in this research. The core component is an integration engine which is implemented according to integration profiles and Health Level Seven (HL7) messages defined in IHE PCD. Working with instrument specific Javascripts, the engine transforms medical instrument data into HL7 ORU message. This research enables medical instruments to interoperate and exchange medical data with information systems in a standardized way, and is valuable for medical instrument integration, especially for traditional instruments.

  12. Extended device profiles and testing procedures for the approval process of integrated medical devices using the IEEE 11073 communication standard.

    Science.gov (United States)

    Janß, Armin; Thorn, Johannes; Schmitz, Malte; Mildner, Alexander; Dell'Anna-Pudlik, Jasmin; Leucker, Martin; Radermacher, Klaus

    2018-02-23

    Nowadays, only closed and proprietary integrated operating room systems (IORS) from big manufacturers are available on the market. Hence, the interconnection of components from third-party vendors is only possible with increased time and costs. In the context of the German Federal Ministry of Education and Research (BMBF)-funded project OR.NET (2012-2016), the open integration of medical devices from different manufacturers was addressed. An integrated operating theater based on the open communication standard IEEE 11073 shall give clinical operators the opportunity to choose medical devices independently of the manufacturer. This approach would be advantageous especially for hospital operators and small- and medium-sized enterprises (SME) of medical devices. Actual standards and concepts regarding technical feasibility and the approval process do not cope with the requirements for a modular integration of medical devices in the operating room (OR), based on an open communication standard. Therefore, innovative approval strategies and corresponding certification and test procedures, which cover actual legal and normative standards, have to be developed in order to support the future risk management and the usability engineering process of open integrated medical devices in the OR. The use of standardized device and service profiles and a three-step testing procedure, including conformity, interoperability and integration tests are described in this paper and shall support the manufacturers to integrate their medical devices without disclosing the medical devices' risk analysis and related confidential expertise or proprietary information.

  13. Benefits and problems in implementation for integrated medical information system

    International Nuclear Information System (INIS)

    Park, Chang Seo; Kim, Kee Deog; Park, Hyok; Jeong, Ho Gul

    2005-01-01

    Once the decision has been made to adopt an integrated medical information system (IMIS), there are a number of tissues to overcome. Users need to be aware of the impact the change will make on end users and be prepared to address issues that arise before they become problems. The purpose of this study is to investigate the benefits and unexpected problems encountered in the implementation of IMIS and to determine a useful framework for IMIS. The Yonsei University Dental Hospital is steadily constructing an IMIS. The vendor's PACS software, Piview STAR, supports transactions between workstations that are approved to integrating the health care enterprise (IHE) with security function. It is necessary to develop an excellent framework that is good for the patient, health care provider and information system vendors, in an expert, efficient, and cost-effective manner. The problems encountered with IMIS implementation were high initial investments, delay of EMR enforcement, underdevelopment of digital radiographic appliances and software and insufficient educational training for users. The clinical environments of dental IMIS is some different from the medical situation. The best way to overcome these differences is to establish a gold standard of dental IMIS integration, which estimates the cost payback. The IHE and its technical framework are good for the patient, the health care provider and all information systems vendors.

  14. In Pursuit of Educational Integrity: Professional Identity Formation in the Harvard Medical School Cambridge Integrated Clerkship.

    Science.gov (United States)

    Gaufberg, Elizabeth; Bor, David; Dinardo, Perry; Krupat, Edward; Pine, Elizabeth; Ogur, Barbara; Hirsh, David A

    2017-01-01

    Graduates of Harvard Medical School's Cambridge Integrated Clerkship (CIC) describe several core processes that may underlie professional identity formation (PIF): encouragement to integrate pre-professional and professional identities; support for learner autonomy in discovering meaningful roles and responsibilities; learning through caring relationships; and a curriculum and an institutional culture that make values explicit. The authors suggest that the benefits of educational integrity accrue when idealistic learners inhabit an educational model that aligns with their own core values, and when professional development occurs in the context of an institutional home that upholds these values. Medical educators should clarify and animate principles within curricula and learning environments explicitly in order to support the professional identity formation of their learners.

  15. An integrated approach to change leadership.

    Science.gov (United States)

    Skelton-Green, Judith; Simpson, Beverley; Scott, Julia

    2007-01-01

    Leading change has become one of the essential core competencies of health professionals today. Since 2001, the authors have been the key designers and facilitators of the Dorothy Wylie Nursing Leadership Institute (DMW-NLI). The background, key characteristics and benefits of the DMW-NLI have been described in detail elsewhere (Simpson et al. 2002). One of the Institute's key features is that participants bring a change initiative that they wish to pursue and - during their time on site - we assist them in developing that project to the point where it has a strong chance of success. When we incorporated this aspect into the DMW-NLI program, we believed that opportunity to apply the learning of the Institute to a desired initiative in the home setting would add significant value, not only to the participants, but also to their sponsoring organizations. Further, it was our hope that we could develop a methodology to advance the change initiative, which would be a valuable tool that participants could use in future change projects.As we looked to the literature, we found no shortage of articles on change theory, as well as numerous tools and techniques for project management. However, we did not find one single approach or methodology that we felt was comprehensive yet concise enough to serve as a practical guide for those who wish to advance a change initiative in their practice settings today. Therefore, we developed an integrated conceptual framework and methodology for leading change initiatives, building on selected current and classic theories of change that are relevant today. Both the framework and methodology have proven very hardy, and will, we believe, be of interest to nurse leaders and other health professionals in leadership roles. This paper will provide a brief overview of relevant background literature on leading change initiatives, introduce the DMW-NLI Change Leadership conceptual framework, describe a number of activities that support the

  16. Data Integration The Relational Logic Approach

    CERN Document Server

    Genesereth, Michael

    2010-01-01

    Data integration is a critical problem in our increasingly interconnected but inevitably heterogeneous world. There are numerous data sources available in organizational databases and on public information systems like the World Wide Web. Not surprisingly, the sources often use different vocabularies and different data structures, being created, as they are, by different people, at different times, for different purposes. The goal of data integration is to provide programmatic and human users with integrated access to multiple, heterogeneous data sources, giving each user the illusion of a sin

  17. The Impact of Technology Integration through a Transformative Approach

    Science.gov (United States)

    Cubillos, Jo Ann

    2013-01-01

    The integration of technology into classroom instruction in K-12 schools remains problematic. The problems associated with this integration are troubling, as technology integration may change a teacher's pedagogy toward more innovative approaches that increase student achievement. The purpose of this study was to document teachers' experiences as…

  18. Merging systems: integrating home visitation and the family-centered medical home.

    Science.gov (United States)

    Tschudy, Megan M; Toomey, Sara L; Cheng, Tina L

    2013-11-01

    To improve the health of children and bend the health care cost curve we must integrate the individual and population approaches to health and health care delivery. The 2012 Institute of Medicine (IOM) report Primary Care and Public Health: Exploring Integration to Improve Population Health laid out the continuum for integration of primary care and public health stretching from isolation to merging systems. Integration of the family-centered medical home (FCMH) and home visitation (HV) would promote overall efficiency and effectiveness and help achieve gains in population health through improving the quality of health care delivered, decreasing duplication, reinforcing similar health priorities, decreasing costs, and decreasing health disparities. This paper aims to (1) provide a brief description of the goals and scope of care of the FCMH and HV, (2) outline the need for integration of the FCMH and HV and synergies of integration, (3) apply the IOM's continuum of integration framework to the FCMH and HV and describe barriers to integration, and (4) use child developmental surveillance and screening as an example of the potential impact of HV-FCMH integration.

  19. XML-based approaches for the integration of heterogeneous bio-molecular data.

    Science.gov (United States)

    Mesiti, Marco; Jiménez-Ruiz, Ernesto; Sanz, Ismael; Berlanga-Llavori, Rafael; Perlasca, Paolo; Valentini, Giorgio; Manset, David

    2009-10-15

    The today's public database infrastructure spans a very large collection of heterogeneous biological data, opening new opportunities for molecular biology, bio-medical and bioinformatics research, but raising also new problems for their integration and computational processing. In this paper we survey the most interesting and novel approaches for the representation, integration and management of different kinds of biological data by exploiting XML and the related recommendations and approaches. Moreover, we present new and interesting cutting edge approaches for the appropriate management of heterogeneous biological data represented through XML. XML has succeeded in the integration of heterogeneous biomolecular information, and has established itself as the syntactic glue for biological data sources. Nevertheless, a large variety of XML-based data formats have been proposed, thus resulting in a difficult effective integration of bioinformatics data schemes. The adoption of a few semantic-rich standard formats is urgent to achieve a seamless integration of the current biological resources.

  20. HeartMath and Ubuntu integral healing approaches for social ...

    African Journals Online (AJOL)

    HeartMath and Ubuntu integral healing approaches for social coherence and physical activity. Stephen D. Edwards. Abstract. This research was motivated by many social health problems confronting planet earth. Its aim is to introduce HeartMath and Ubuntu as complimentary, integral healing approaches for promoting ...

  1. AIM: An Integrated Approach to Organizational Improvement

    Directory of Open Access Journals (Sweden)

    Ronald A. Styron, Jr.

    2016-02-01

    Full Text Available This concept paper is based on the new problem-solving model of Blended Leadership called Alloy Improvement Model (AIM. This model consists of an integration of change theory, leadership theory, and democratic principles and practices to form a comprehensive problem-solving strategy for organizational leaders. The utilization of AIM will assist leaders in moving from problems to solutions while engaging stakeholders in a comprehensive, efficient, inclusive, informative, integrated and transparent process.

  2. Integration testing through reusing representative unit test cases for high-confidence medical software.

    Science.gov (United States)

    Shin, Youngsul; Choi, Yunja; Lee, Woo Jin

    2013-06-01

    As medical software is getting larger-sized, complex, and connected with other devices, finding faults in integrated software modules gets more difficult and time consuming. Existing integration testing typically takes a black-box approach, which treats the target software as a black box and selects test cases without considering internal behavior of each software module. Though it could be cost-effective, this black-box approach cannot thoroughly test interaction behavior among integrated modules and might leave critical faults undetected, which should not happen in safety-critical systems such as medical software. This work anticipates that information on internal behavior is necessary even for integration testing to define thorough test cases for critical software and proposes a new integration testing method by reusing test cases used for unit testing. The goal is to provide a cost-effective method to detect subtle interaction faults at the integration testing phase by reusing the knowledge obtained from unit testing phase. The suggested approach notes that the test cases for the unit testing include knowledge on internal behavior of each unit and extracts test cases for the integration testing from the test cases for the unit testing for a given test criteria. The extracted representative test cases are connected with functions under test using the state domain and a single test sequence to cover the test cases is produced. By means of reusing unit test cases, the tester has effective test cases to examine diverse execution paths and find interaction faults without analyzing complex modules. The produced test sequence can have test coverage as high as the unit testing coverage and its length is close to the length of optimal test sequences. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Wilber's Integral Theory and Dossey's Theory of Integral Nursing: An Examination of Two Integral Approaches in Nursing Scholarship.

    Science.gov (United States)

    Shea, Linda; Frisch, Noreen

    2016-09-01

    The purpose of this article is to examine Dossey's theory of integral nursing in relation to its major theoretical source, Wilber's integral theory. Although several nursing scholars have written about integral theory in relation to nursing scholarship and practice, Dossey's theory of integral nursing may be influencing how nurses take up integral theory in a significant way due to an extensive outreach in the holistic nursing community. Despite this wide circulation, the theory of integral nursing has yet to be reviewed in the nursing literature. This article (a) compares Dossey's theory of integral nursing with Wilber's integral theory and (b) contrasts Dossey's integral approach with another integral approach used by other scholars of integral theory. © The Author(s) 2015.

  4. Integrating the results of user research into medical device development: insights from a case study

    Directory of Open Access Journals (Sweden)

    Martin Jennifer L

    2012-07-01

    Full Text Available Abstract Background It is well established that considering users is an important aspect of medical device development. However it is also well established that there are numerous barriers to successfully conducting user research and integrating the results into product development. It is not sufficient to simply conduct user research, it must also be effectively integrated into product development. Methods A case study of the development of a new medical imaging device was conducted to examine in detail how users were involved in a medical device development project. Two user research studies were conducted: a requirements elicitation interview study and an early prototype evaluation using contextual inquiry. A descriptive in situ approach was taken to investigate how these studies contributed to the product development process and how the results of this work influenced the development of the technology. Data was collected qualitatively through interviews with the development team, participant observation at development meetings and document analysis. The focus was on investigating the barriers that exist to prevent user data from being integrated into product development. Results A number of individual, organisational and system barriers were identified that functioned to prevent the results of the user research being fully integrated into development. The user and technological aspects of development were seen as separate work streams during development. The expectations of the developers were that user research would collect requirements for the appearance of the device, rather than challenge its fundamental concept. The manner that the user data was communicated to the development team was not effective in conveying the significance or breadth of the findings. Conclusion There are a range of informal and formal organisational processes that can affect the uptake of user data during medical device development. Adopting formal decision

  5. Integrating the results of user research into medical device development: insights from a case study.

    Science.gov (United States)

    Martin, Jennifer L; Barnett, Julie

    2012-07-19

    It is well established that considering users is an important aspect of medical device development. However it is also well established that there are numerous barriers to successfully conducting user research and integrating the results into product development. It is not sufficient to simply conduct user research, it must also be effectively integrated into product development. A case study of the development of a new medical imaging device was conducted to examine in detail how users were involved in a medical device development project. Two user research studies were conducted: a requirements elicitation interview study and an early prototype evaluation using contextual inquiry. A descriptive in situ approach was taken to investigate how these studies contributed to the product development process and how the results of this work influenced the development of the technology. Data was collected qualitatively through interviews with the development team, participant observation at development meetings and document analysis. The focus was on investigating the barriers that exist to prevent user data from being integrated into product development. A number of individual, organisational and system barriers were identified that functioned to prevent the results of the user research being fully integrated into development. The user and technological aspects of development were seen as separate work streams during development. The expectations of the developers were that user research would collect requirements for the appearance of the device, rather than challenge its fundamental concept. The manner that the user data was communicated to the development team was not effective in conveying the significance or breadth of the findings. There are a range of informal and formal organisational processes that can affect the uptake of user data during medical device development. Adopting formal decision making processes may assist manufacturers to take a more integrated and

  6. Family welfare programme calls for an integrated approach.

    Science.gov (United States)

    Singh, P N

    3 phases can be identified in India's family planning program in the 4 decades since the country achieved its independence: a stage designed to improve the infrastructure of family planning; a phase of integration of different health and family welfare services; and an attempt of community involvement and universal coverage. At this time there is a widespread infrastructure and a growing awareness of family planning services. The birthrate has declined from 41.2/1000 in the 1960s to 33.3/1000 in the 1980s; the mortality rate declined from 27.4 to 14.2. The current facilities of family welfare services are inadequate, particularly in rural areas. The present provision of auxiliary nurse midwives (ANMS) at the rate of 1/5000 can cover effectively only 1/3 of eligible couples. Further, in rural areas, communication and motivational efforts are lacking as well as easy availability of personnel and medical supplies. Finally, about 40% of the rural population lives below the poverty line and have not reached the economic threshold which is essential for adoption of the small family norm. The primary issue is to deal with the problem of social development. The emphasis needs to be on an integrated and package approach to economic progress and social transformation coupled with the family planning program. The best way to bring about the needed socioeconomic change is to provide educational and gainful employment opportunities.

  7. An Integrated DEMATEL-QFD Model for Medical Supplier Selection

    OpenAIRE

    Mehtap Dursun; Zeynep Şener

    2014-01-01

    Supplier selection is considered as one of the most critical issues encountered by operations and purchasing managers to sharpen the company’s competitive advantage. In this paper, a novel fuzzy multi-criteria group decision making approach integrating quality function deployment (QFD) and decision making trial and evaluation laboratory (DEMATEL) method is proposed for supplier selection. The proposed methodology enables to consider the impacts of inner dependence among supplier assessment cr...

  8. Investigation of Integrated Vehicle Health Management Approaches

    Science.gov (United States)

    Paris, Deidre

    2005-01-01

    This report is to present the work that was performed during the summer in the Advance Computing Application office. The NFFP (NASA Faculty Fellow Program) had ten summer faculty members working on IVHM (Integrated Vehicle Health Management) technologies. The objective of this project was two-fold: 1) to become familiar with IVHM concepts and key demonstrated IVHM technologies; and 2) to integrate the research that has been performed by IVHM faculty members into the MASTLAB (Marshall Avionic Software Test Lab). IVHM is a NASA-wide effort to coordinate, integrate and apply advanced software, sensors and design technologies to increase the level of intelligence, autonomy, and health state of future vehicles. IVHM is an important concept because it is consistent with the current plan for NASA to go to the moon, mars, and beyond. In order for NASA to become more involved in deep exploration, avionic systems will need to be highly adaptable and autonomous.

  9. Sleep Disruption Medical Intervention Forecasting (SDMIF) Module for the Integrated Medical Model

    Science.gov (United States)

    Lewandowski, Beth; Brooker, John; Mallis, Melissa; Hursh, Steve; Caldwell, Lynn; Myers, Jerry

    2011-01-01

    The NASA Integrated Medical Model (IMM) assesses the risk, including likelihood and impact of occurrence, of all credible in-flight medical conditions. Fatigue due to sleep disruption is a condition that could lead to operational errors, potentially resulting in loss of mission or crew. Pharmacological consumables are mitigation strategies used to manage the risks associated with sleep deficits. The likelihood of medical intervention due to sleep disruption was estimated with a well validated sleep model and a Monte Carlo computer simulation in an effort to optimize the quantity of consumables. METHODS: The key components of the model are the mission parameter program, the calculation of sleep intensity and the diagnosis and decision module. The mission parameter program was used to create simulated daily sleep/wake schedules for an ISS increment. The hypothetical schedules included critical events such as dockings and extravehicular activities and included actual sleep time and sleep quality. The schedules were used as inputs to the Sleep, Activity, Fatigue and Task Effectiveness (SAFTE) Model (IBR Inc., Baltimore MD), which calculated sleep intensity. Sleep data from an ISS study was used to relate calculated sleep intensity to the probability of sleep medication use, using a generalized linear model for binomial regression. A human yes/no decision process using a binomial random number was also factored into sleep medication use probability. RESULTS: These probability calculations were repeated 5000 times resulting in an estimate of the most likely amount of sleep aids used during an ISS mission and a 95% confidence interval. CONCLUSIONS: These results were transferred to the parent IMM for further weighting and integration with other medical conditions, to help inform operational decisions. This model is a potential planning tool for ensuring adequate sleep during sleep disrupted periods of a mission.

  10. Approaches to Integrated Building Design Environments

    DEFF Research Database (Denmark)

    Bagger-Petersen, Susanne C; Andersen, Tom

    1996-01-01

    This report discusses functional requirements and specification which needs to be defined and fulfilled to initiate development of an integrated building design environment. The purpose is to outline specifications for further discussion and development. The report documents the first phase...... in an ongoing project at the Technical University of Denmark. The overall project objective is to provide a theoretically well-founded prototype of an integrated IT-system which can serve as a device of feedback from practice and as a test-bed for the developed concept and architecture....

  11. Field theory a path integral approach

    CERN Document Server

    Das, Ashok

    2006-01-01

    This unique book describes quantum field theory completely within the context of path integrals. With its utility in a variety of fields in physics, the subject matter is primarily developed within the context of quantum mechanics before going into specialized areas.Adding new material keenly requested by readers, this second edition is an important expansion of the popular first edition. Two extra chapters cover path integral quantization of gauge theories and anomalies, and a new section extends the supersymmetry chapter, where singular potentials in supersymmetric systems are described.

  12. Oncology Education in Medical Schools: Towards an Approach that Reflects Australia's Health Care Needs.

    Science.gov (United States)

    McRae, Robert J

    2016-12-01

    Cancer has recently overtaken heart disease to become the number 1 cause of mortality both globally and in Australia. As such, adequate oncology education must be an integral component of medical school if students are to achieve learning outcomes that meet the needs of the population. The aim of this review is to evaluate the current state of undergraduate oncology education and identify how Australian medical schools can improve oncology learning outcomes for students and, by derivative, improve healthcare outcomes for Australians with cancer. The review shows that oncology is generally not well represented in medical school curricula, that few medical schools offer mandatory oncology or palliative care rotations, and that junior doctors are exhibiting declining oncology knowledge and skills. To address these issues, Australian medical schools should implement the Oncology Education Committee's Ideal Oncology Curriculum, enact mandatory oncology and palliative care clinical rotations for students, and in doing so, appreciate the importance of students' differing approaches to learning.

  13. The Integration Movement in the Caribbean at Crossroads: Towards a New Approach of Integration

    OpenAIRE

    Uziel Nogueira

    1997-01-01

    The Institute for the Integration of Latin America and the Caribbean (INTAL) has inaugurated a Working Papers Series with the publication of a study by Uziel Nogueira, the Institute's Economist. Entitled "The Integration Movement in the Caribbean at the Crossroads: Towards a New Approach to Integration", the study opens with an overview of the movement towards integration among the English-speaking countries of the Caribbean. It continues with an analysis of the integration process during thi...

  14. Pediatric disaster preparedness in the medical setting: integrating mental health.

    Science.gov (United States)

    Gold, Jeffrey I; Montano, Zorash; Shields, Sandra; Mahrer, Nicole E; Vibhakar, Viktoria; Ybarra, Tanya; Yee, Nancy; Upperman, Jeffrey; Blake, Nancy; Stevenson, Kathleen; Nager, Alan L

    2009-01-01

    The increasing prevalence of disasters worldwide highlights the need for established and universal disaster preparedness plans. The devastating events of September 11 and Hurricane Katrina have spurred the development of some disaster response systems. These systems, however, are predominantly focused on medical needs and largely overlook mental health considerations. Negative outcomes of disasters include physical damage as well as psychological harm. Mental health needs should be considered throughout the entire disaster response process, especially when caring for children, adolescents, and their families. To provide an overview and recommendations for the integration of mental health considerations into pediatric disaster preparedness and response in the medical setting. Recommendations were developed by a panel of disaster preparedness and mental health experts during the Childrens Hospital Los Angeles Pediatric Disaster Resource and Training Center: Workshop on Family Reunification in Los Angeles, California, March 31-April 1, 2008. Experts discussed the inclusion of mental health-specific considerations and services at all stages of disaster preparedness and response. Recommendations involve the integration of mental health into triage and tracking, the adoption of a child ambassador model, environment, and developmentally appropriate interventions, education, communication, death notification, and family reunification. The inclusion of mental health concerns into pediatric disaster preparedness may help prevent further and unnecessary psychological harm to children and adolescent survivors following a disaster.

  15. An Integrated Approach to Teaching Agriculture.

    Science.gov (United States)

    Jenkinson, G. M.; And Others

    1989-01-01

    Outlines developments that took place in teaching agriculture at the freshman-sophomore level and the concept of integrated courses in agriculture. Future directions include: more emphasis on the impact of technology, case-study forms, and efforts to shift the balance from content to concept. (Author/RT)

  16. Development of Multisensory Integration Approach Model

    Science.gov (United States)

    Kumar, S. Prasanna; Nathan, B. Sami

    2016-01-01

    Every teacher expects optimum level of processing in mind of them students. The level of processing is mainly depends upon memory process. Most of the students have retrieval difficulties on past learning. Memory difficulties directly related to sensory integration. In these circumstances the investigator made an attempt to construct Multisensory…

  17. A Symmetric Approach Elucidates Multisensory Information Integration

    Directory of Open Access Journals (Sweden)

    Arturo Tozzi

    2016-12-01

    Full Text Available Recent advances in neuronal multisensory integration suggest that the five senses do not exist in isolation of each other. Perception, cognition and action are integrated at very early levels of central processing, in a densely-coupled system equipped with multisensory interactions occurring at all temporal and spatial stages. In such a novel framework, a concept from the far-flung branch of topology, namely the Borsuk-Ulam theorem, comes into play. The theorem states that when two opposite points on a sphere are projected onto a circumference, they give rise to a single point containing their matching description. Here we show that the theorem applies also to multisensory integration: two environmental stimuli from different sensory modalities display similar features when mapped into cortical neurons. Topological tools not only shed new light on questions concerning the functional architecture of mind and the nature of mental states, but also provide an empirically assessable methodology. We argue that the Borsuk-Ulam theorem is a general principle underlying nervous multisensory integration, resulting in a framework that has the potential to be operationalized.

  18. Integrated approach to economical, reliable, safe nuclear power production

    International Nuclear Information System (INIS)

    1982-06-01

    An Integrated Approach to Economical, Reliable, Safe Nuclear Power Production is the latest evolution of a concept which originated with the Defense-in-Depth philosophy of the nuclear industry. As Defense-in-Depth provided a framework for viewing physical barriers and equipment redundancy, the Integrated Approach gives a framework for viewing nuclear power production in terms of functions and institutions. In the Integrated Approach, four plant Goals are defined (Normal Operation, Core and Plant Protection, Containment Integrity and Emergency Preparedness) with the attendant Functional and Institutional Classifications that support them. The Integrated Approach provides a systematic perspective that combines the economic objective of reliable power production with the safety objective of consistent, controlled plant operation

  19. Canadian National Guidelines and Recommendations for Integrating Career Advising Into Medical School Curricula.

    Science.gov (United States)

    Howse, Kelly; Harris, June; Dalgarno, Nancy

    2017-11-01

    Career planning, decision making about specialty choice, and preparation for residency matching are significant sources of stress for medical students. Attempts have been made to structure and formalize career advising by including it in accreditation standards. There is an expressed need for national guidelines on career advising for medical students. The Future of Medical Education in Canada Postgraduate (FMEC PG) Implementation Project was created to ensure Canadian medical trainees receive the best education possible. From this, a diverse sub-working group (SWG), representing different Canadian regions, was formed to review career advising processes across the country. The SWG developed, through a modified formal consensus methodology, a strategy for medical student career advising that is adaptable to all schools in alignment with existing accreditation standards. The SWG outlined five guiding principles and five essential elements for Canadian universities offering an MD degree with recommendations on how to integrate the elements into each school's career advising system. The five essential elements are a structured approach to career advising, information about available career options, elective guidance, preparation for residency applications, and social accountability. This Perspective endorses the view of the FMEC PG Implementation Project that national guidelines are important to ensure Canadian medical schools are consistently meeting accreditation standards by providing reliable and quality career advising to all medical students. The SWG's position, based on national and provincial feedback, is that these guidelines will stimulate discourse and action regarding the requirements and processes to carry out these recommendations nationwide and share across borders.

  20. Ramjets: Thermal Management an Integrated Engineering Approach

    Science.gov (United States)

    2010-09-01

    and Thermal Management (Propulsion a vitesse elevee : Conception du moteur - integration et gestion thermique ) 14. ABSTRACT Within the framework of...2.0 AERODYNAMIC HEATING 2.1 General Heat Transfer Relations The air flow around any vehicle moving through the atmosphere comes to rest at the...resulting in a convective heat flux from the air flow to the structure of the vehicle. The basic equation describing convective heat transfer is: )( wawcc

  1. The line integral approach to radarclinometry

    Science.gov (United States)

    Wildey, R.L.

    1987-01-01

    Radarclinometry, the invention of which has been previously reported, is a technique for deriving a topographic map from a single radar image by using the dependence upon terrain-surface orientation of the integrated signal of an individual image pixel. The radiometric calibration required for precise operation and testing does not yet exist, but the imminence of important applications justifies parallel, rather than serial, development of radarclinometry and radiometrically calibrated radar. The present investigation reports three developmental advances: (1) The solid angle of integration of back-scattered specific intensity constituting a pixel signal is more accurately accounted for in its dependence on surface orientation than in previous work. (2) The local curvature hypothesis, which removes the requirement of a ground-truth profile as a boundary condition and enables the formulation of the theory in terms of a line integral, has been expanded to include the three possibilities of Local Cylindricity, Local Biaxial Ellipsoidal Hyperbolicity, and Least-Squares Local Sphericity. (3) The theory is integrated in the cross-ground-range direction, which is ill-conditioned compared to the ground-range direction, whereas the original formulation was based on enforced isotropy in the two-dimensional power spectrum of the topography. It was found necessary to prohibit the hypothesis of Local Biaxial Ellipsoidal Hyperbolicity in the cross-range stepping, for reasons not completely clear. Variation in the proportioning between curvature assumptions had produced topographic maps that are in good mutual agreement but not realistic in appearance. They are severely banded parallel to the ground-range direction, most especially at small radar zenith angles. Numerical experimentation with the falsification of topography through incorrect decalibration as performed on a Gaussian hill suggests that the banding and its exaggeration at high radar incidence angles could easily be

  2. Concept for integrated environmental monitoring. Scientific approach

    Energy Technology Data Exchange (ETDEWEB)

    Haber, W. [comp.; Schoenthaler, K.; Kerner, H.F.; Koeppel, J.; Spandau, L.

    1998-09-01

    Despite considerable expenditures for environmental protection and intensified efforts in the areas of environmental research and monitoring, environmental damage increasingly occurs, sometimes with global effects, largely due to the lack of early diagnosis. In the past few years various institutions have therefore demanded improvements in environmental monitoring. The Council of Experts on Environmental Issues (`Rat von Sachverstaendigen fuer Umweltfragen`, SRU), in particular, in its `Environmental Report` of 1987 and in its Special Report on `General Ecological Environmental Monitoring` (1990) presented far-reaching demands for a nationwide ecological early warning system which should integrate the various local, regional, national, and even global monitoring levels, and which should encompass an environmental monitoring of entire ecosystems at representative locations. This is aimed at creating the prerequisites for - detection of long-term gradual environmental change, - confirmation of refutation of initial assumptions regarding the causes of these environmental changes, - permitting decisions on preventive actions to stabilize or improve environmental conditions and - making it possible to assess the success of environmental protection policies. This report includes an abbreviated version and documentation of the conference on the `Concept for Integrated Environmental Monitoring` and the final report `Specification of the Concept for Integrated Environmental Monitoring from the Perspective of Nature Conservation`. (orig.)

  3. Journal of Mind and Medical Sciences: translational and integrative mission

    Directory of Open Access Journals (Sweden)

    David L. Rowland

    2017-04-01

    Full Text Available Initiated four years ago, Journal of Mind and Medical Sciences (J Mind Med Sci. established the mission to publish papers on mental and medical topics in distinct but closely interrelated domains. The editorial policy especially encourages interdisciplinary and integrative perspectives, being equally focused on basic research and clinical investigations and short reports. The journal adheres to the philosophy that high quality, original ideas and information should be readily accessible and freely shared within and amongst the scientific community. Accordingly, J Mind Med Sci. is an online, open access, non-for-profit journal which, because of individual/ private support, has levied no charges for submission, review, and publication of articles. All published articles may be freely downloaded and used by anyone from anywhere for scientific purposes. Journal of Mind and Medical Sciences is published by ValpoScholar/ Valparaiso University using the leading institutional repository platform of Digital Commons (powered by Bepress and under the local management of Jon Bull, Library Services, Valparaiso University, which combines submission management, editorial, and peer-review tools into a unique and flexible publishing software system. These editorial and publishing norms have facilitated the journal’s evolution, now indexed and abstracted in several international respected databases. Journal visibility is wide among international academic institutions and readers, as documented by the number of downloaded articles cited in respected journals, some indexed by Thomson Reuters and having high impact factors. In addition, published authors in J Mind Med Sci. periodically receive a statistical report about views / downloads of their articles. It is a pleasure and honor to thank all those who have thus far supported the journal activity (authors, reviewers, editorial board and assistance, publishing support, and to further invite and encourage

  4. Medical students' attitudes towards the primary health care approach

    African Journals Online (AJOL)

    A qualitative approach was taken and focus groups and interviews were conducted with second, third and fourth-year medical students from UCT. ... Students' struggle with the incongruence between what is perceived as the idealistic theory of PHC and the reality of health care in South Africa is also an issue that needs to ...

  5. Valuing groundwater: A practical approach for integrating ...

    African Journals Online (AJOL)

    ... Community (SADC) Groundwater and Drought Management Project. This methodology can be generally applied to groundwater management issues across the SADC region. The methodology is based upon an ecosystem services approach which considers all the potential services that groundwater provides, which can ...

  6. New Theoretical Approach Integrated Education and Technology

    Science.gov (United States)

    Ding, Gang

    2010-01-01

    The paper focuses on exploring new theoretical approach in education with development of online learning technology, from e-learning to u-learning and virtual reality technology, and points out possibilities such as constructing a new teaching ecological system, ubiquitous educational awareness with ubiquitous technology, and changing the…

  7. Alcoholism: integrating approaches to influence policy

    African Journals Online (AJOL)

    Adele

    Most importantly that these disorders are treatable and treatment can be cost effective. It is crucial that we continually challenge our assumptions of best treatment practices. Rehabilitation programs in the. USA have in the last decade radically changed their approach to treatment, providing most treatment in ambulatory reha ...

  8. Urban energy systems an integrated approach

    CERN Document Server

    Keirstead, James

    2013-01-01

    Energy demands of cities need to be met more sustainably. This book analyses the technical and social systems that satisfy these needs and asks how methods can be put into practice to achieve this.Drawing on analytical tools and case studies developed at Imperial College London, the book presents state-of-the-art techniques for examining urban energy systems as integrated systems of technologies, resources, and people.Case studies include:a history of the evolution of London's urban energy system, from pre-history to present daya history of the growth of d

  9. Design of Integrated Circuits Approaching Terahertz Frequencies

    DEFF Research Database (Denmark)

    Yan, Lei

    are designed based on the monolithic membrane supported Schottky diodes, which is under development at Chalmers University of Technology, Sweden. To simplify the baseband circuitry, the received IF signal from the subharmonic mixer is further amplified and downconverted to the DC range with a low noise...... heterodyne receivers with requirements of room temperature operation, low system complexity, and high sensitivity, monolithic integrated Schottky diode technology is chosen for the implementation of submillimeterwave components. The corresponding subharmonic mixer and multiplier for a THz radiometer system...

  10. [Medical approach to liability for malpractice originating during health services].

    Science.gov (United States)

    Haller, Herman

    2008-01-01

    In this paper approach of medical liability for malpractice originating during health services is analysed and elaborated. It coud be defined as comprehensive outcome of law, ethical, financial, environmental, staff and equipmental factors. Professional liability in medicine should be viewed from the next factors: competence, information, confidence, relationship between all partitioners, quality of health care, feasibility, economics, accepted scientific level, absence of conflic of interest and professional level. Today, medicine encounters explosion of knowledge and technology, new diseases, population ageing, informatic transformation, promotion of health, reinforcement of human rights and patient's rights, partnerships, role of health market as well as globalisation. In such circumstances medical staff achieve medical liability in more complex conditions and in growing population's expectations. Only partners relationship between all partitioner, deciders, participants and users of health system could define suitable and acceptable medical liability.

  11. The Role of an Integrated Approach in Music Education Technology

    Directory of Open Access Journals (Sweden)

    Natalia Popovych

    2014-04-01

    Full Text Available The purpose of this paper is to justify the role of integrated approach to music education of students. This requires the implementation of a theoretical analysis of the meaning and importance of an integrated approach to music education and training, determination of didactic conditions of integrating the music education in schools and coverage of methods of arrangement of the complex relationships of the main types of educational and creative activity for students in music lessons. It is proved that an integrated approach to the music education process causes the appearance of new original teaching forms and techniques that brings the process to a new qualitative level, enriching the musical and creative abilities of students, enabling them to realize the artistic and aesthetic taste preferences, to achieve the integrity of musical and creative development and high levels of formation of aesthetic consciousness and music.

  12. Integral bridge abutment-to-approach slab connection.

    Science.gov (United States)

    2008-06-01

    The Iowa Department of Transportation has long recognized that approach slab pavements of integral abutment bridges are prone to settlement and cracking, which manifests as the "bump at the end of the bridge". A commonly recommended solution is to in...

  13. SESSION V: INTEGRATED APPROACHES IN LAND AND WATER ...

    African Journals Online (AJOL)

    SESSION V: INTEGRATED APPROACHES IN LAND AND WATER MANAGEMENT RESEARCH/LAND AND WATER MANAGEMENT ECONOMICS AND POLICY - Socioeconomic implications of improved forage species on smallholder farms in Kenya.

  14. Integrating bioavailability approaches into waste rock evaluations

    Science.gov (United States)

    Ranville, James F.; Blumenstein, E. P.; Adams, Michael J.; Choate, LaDonna M.; Smith, Kathleen S.; Wildeman, Thomas R.

    2006-01-01

    The presence of toxic metals in soils affected by mining, industry, agriculture and urbanization, presents problems to human health, the establishment and maintenance of plant and animal habitats, and the rehabilitation of affected areas. A key to managing these problems is predicting the fraction of metal in a given soil that will be biologically labile, and potentially harmful ('bioavailable'). The molecular form of metals and metalloids, particularly the uncomplexed (free) form, controls their bioavailability and toxicity in solution. One computational approach for determining bioavailability, the biotic ligand model (BLM), takes into account not only metal complexation by ligands in solution, but also competitive binding of hardness cations (Ca 2+,Mg 2+,) and metal ions to biological receptor sites. The more direct approach to assess bioavailability is to explicitly measure the response of an organism to a contaminant. A number of microbial enzyme tests have been developed to assess the impact of pollution in a rapid and procedurally simple way. These different approaches in making bioavailability predictions may have value in setting landuse priorities, remediation goals, and habitat reclamation strategies.

  15. Sensitivity Analysis of the Integrated Medical Model for ISS Programs

    Science.gov (United States)

    Goodenow, D. A.; Myers, J. G.; Arellano, J.; Boley, L.; Garcia, Y.; Saile, L.; Walton, M.; Kerstman, E.; Reyes, D.; Young, M.

    2016-01-01

    Sensitivity analysis estimates the relative contribution of the uncertainty in input values to the uncertainty of model outputs. Partial Rank Correlation Coefficient (PRCC) and Standardized Rank Regression Coefficient (SRRC) are methods of conducting sensitivity analysis on nonlinear simulation models like the Integrated Medical Model (IMM). The PRCC method estimates the sensitivity using partial correlation of the ranks of the generated input values to each generated output value. The partial part is so named because adjustments are made for the linear effects of all the other input values in the calculation of correlation between a particular input and each output. In SRRC, standardized regression-based coefficients measure the sensitivity of each input, adjusted for all the other inputs, on each output. Because the relative ranking of each of the inputs and outputs is used, as opposed to the values themselves, both methods accommodate the nonlinear relationship of the underlying model. As part of the IMM v4.0 validation study, simulations are available that predict 33 person-missions on ISS and 111 person-missions on STS. These simulated data predictions feed the sensitivity analysis procedures. The inputs to the sensitivity procedures include the number occurrences of each of the one hundred IMM medical conditions generated over the simulations and the associated IMM outputs: total quality time lost (QTL), number of evacuations (EVAC), and number of loss of crew lives (LOCL). The IMM team will report the results of using PRCC and SRRC on IMM v4.0 predictions of the ISS and STS missions created as part of the external validation study. Tornado plots will assist in the visualization of the condition-related input sensitivities to each of the main outcomes. The outcomes of this sensitivity analysis will drive review focus by identifying conditions where changes in uncertainty could drive changes in overall model output uncertainty. These efforts are an integral

  16. Integrated reporting: A new approach to corporate reporting and management

    OpenAIRE

    Prošić Danica

    2015-01-01

    Integrated reporting is an opportunity to present a comprehensive picture of one's business in a clear, concise, coherent and comparable way. The idea of an integrated reporting and integration with non-financial data in the annual reports has many advantages and benefits compared to the current model of corporate reporting. Such approach enables us to consider the material issues facing our business and the community, and show how we create value for shareholders and society as a whole. At t...

  17. An integrated approach for prioritized process improvement.

    Science.gov (United States)

    Vanteddu, Gangaraju; McAllister, Charles D

    2014-01-01

    The purpose of this paper is to propose an integrated framework to simultaneously identify and improve healthcare processes that are important from the healthcare provider's and patient's perspectives. A modified quality function deployment (QFD) chart is introduced to the field of healthcare quality assurance. A healthcare service example is used to demonstrate the utility of the proposed chart. The proposed framework is versatile and can be used in a wide variety of healthcare quality improvement contexts, wherein, two different perspectives are needed to be considered for identifying and improving critical healthcare processes. The modified QFD chart used in conjunction with the stacked Pareto chart will facilitate the identification of key performance metrics from the patient's and the hospital's perspectives. Subsequently, the chief contributory factors at different levels are identified in a very efficient manner. Healthcare quality improvement professionals will be able to use the proposed modified QFD chart in association with stacked Pareto chart for effective quality assurance.

  18. Regional Integrated Silvopastoral Approaches to Ecosystem Management Project

    OpenAIRE

    CIPAV (Centre For Research on Sustainable Agricultural Production Systems); CATIE (Centro Agronomico Tropical de Investigacion y Ensenanza); NITLAPAN

    2007-01-01

    Metadata only record The Regional Integrated Silvopastoral Approaches to Ecosystem Management Project introduces the payment for environmental services approach to silvopastoral farmers in Colombia, Costa Rica, and Nicaragua. The objectives of the project are to "demonstrate and measure a) the effects the introduction of payment incentives for environmental services to farmers on their adoption of integrated silvopastoral farming systems in degraded pasture lands; and b) the resulting impr...

  19. Integrated Approach to Address Food and Nutrition Security in the ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Integrated Approach to Address Food and Nutrition Security in the Philippines. Malnutrition remains a serious problem in the Philippines, especially among children. Could integrated garden and nutrition programs at schools help address the problem? An estimated 3 million children in the Philippines are undernourished.

  20. Architecture for Integrated Medical Model Dynamic Probabilistic Risk Assessment

    Science.gov (United States)

    Jaworske, D. A.; Myers, J. G.; Goodenow, D.; Young, M.; Arellano, J. D.

    2016-01-01

    Probabilistic Risk Assessment (PRA) is a modeling tool used to predict potential outcomes of a complex system based on a statistical understanding of many initiating events. Utilizing a Monte Carlo method, thousands of instances of the model are considered and outcomes are collected. PRA is considered static, utilizing probabilities alone to calculate outcomes. Dynamic Probabilistic Risk Assessment (dPRA) is an advanced concept where modeling predicts the outcomes of a complex system based not only on the probabilities of many initiating events, but also on a progression of dependencies brought about by progressing down a time line. Events are placed in a single time line, adding each event to a queue, as managed by a planner. Progression down the time line is guided by rules, as managed by a scheduler. The recently developed Integrated Medical Model (IMM) summarizes astronaut health as governed by the probabilities of medical events and mitigation strategies. Managing the software architecture process provides a systematic means of creating, documenting, and communicating a software design early in the development process. The software architecture process begins with establishing requirements and the design is then derived from the requirements.

  1. Introduction of Integrative Health and Acupuncture to Pre-Clerkship Medical Students

    OpenAIRE

    Leggit, Jeffrey C.

    2014-01-01

    Background: Pain is a common diagnosis in both the civilian and military community. Integrative health practices, such as acupuncture, are often used to treat pain as well as other medical conditions. Medical schools must ensure that their students are aware of what patients are using and how the tools of Integrative Health can be used together with the conventional medical model.

  2. Structural characterisation of medically relevant protein assemblies by integrating mass spectrometry with computational modelling.

    Science.gov (United States)

    Politis, Argyris; Schmidt, Carla

    2018-03-20

    Structural mass spectrometry with its various techniques is a powerful tool for the structural elucidation of medically relevant protein assemblies. It delivers information on the composition, stoichiometries, interactions and topologies of these assemblies. Most importantly it can deal with heterogeneous mixtures and assemblies which makes it universal among the conventional structural techniques. In this review we summarise recent advances and challenges in structural mass spectrometric techniques. We describe how the combination of the different mass spectrometry-based methods with computational strategies enable structural models at molecular levels of resolution. These models hold significant potential for helping us in characterizing the function of protein assemblies related to human health and disease. In this review we summarise the techniques of structural mass spectrometry often applied when studying protein-ligand complexes. We exemplify these techniques through recent examples from literature that helped in the understanding of medically relevant protein assemblies. We further provide a detailed introduction into various computational approaches that can be integrated with these mass spectrometric techniques. Last but not least we discuss case studies that integrated mass spectrometry and computational modelling approaches and yielded models of medically important protein assembly states such as fibrils and amyloids. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  3. Major Approaches to Medical Diagnosis and their Drawbacks

    Directory of Open Access Journals (Sweden)

    Sabina MUNTEANU

    2009-12-01

    Full Text Available The ability to reason within a dynamical environment is of a crucial importance in Artificial Intelligence. Medical diagnosis is a dynamic and very complex field which needs special attention Our quest is for a system for medical diagnosis, that could model its search space efficiently and dynamically, while confronted with sequential tests. We present below some of the major approaches from literature, with their drawbacks, and conclude that a combinative hybridization of a certain type would be useful to overcome the failures.

  4. Marketing-oriented organizations: an integrated approach.

    Science.gov (United States)

    Stensrud, R; Arrington, B

    1988-03-01

    Organizations can be oriented toward marketing from a production, product, sales, or marketing perspective. Strategies, structures, and cultures, which reflect a company's basic orientation, must be integrated to ensure that marketing efforts communicate a clear corporate position. In a study of 31 hospitals, the Center for Health Services Education Research, St. Louis University, found that no hospital's organization fit neatly into a single category. For example, a hospital may have some service lines that were marketing oriented while other lines were production oriented. The majority of hospitals, however, were product oriented, focusing on productivity and financial performance rather than on market factors. The most effective sales orientation was observed in the for-profits. Their selling efforts, however, tended to be internally focused, with product development activities divorced from the planning and marketing functions. Only the for-profit hospitals showed the beginning of a marketing orientation. Developing a marketing orientation, especially in line divisions, requires a careful, well-orchestrated effort and the presence of several key factors: Access to capital and an emphasis on long-range planning and strategic spending The availability of hospital-specific market research. Key distribution channels. Talented middle managers. Up-to-date systems and structures equipped to serve new values and strategies. Leaders capable of communicating to the organization a vision of its role in the community.

  5. Integrating lifestyle approaches into osteoarthritis care

    Directory of Open Access Journals (Sweden)

    Garver MJ

    2015-09-01

    Full Text Available Matthew J Garver,1 Brian C Focht,2 Sarah J Taylor3 1Department of Kinesiology and Nutrition, Abilene Christian University, Abilene, TX, 2Department of Human Sciences, Ohio State University, Columbus, OH, 3School of Occupational Therapy, Texas Woman's University, Dallas, TX, USA Abstract: As the lifetime risk, societal cost, and overall functional impact of osteoarthritis (OA is imposing, it is imperative that clinicians provide an individualized care model for patients. Patients must be offered a multiplicity of care strategies and encouraged to embrace lifestyle approaches for self-managing the effects and symptoms of OA. Certainly, the attitude of the clinician and patient will directly influence receptivity and implementation of lifestyle approaches. This work proposes how the use of structured and routine assessments and cognitive therapy ideologies may complement a comprehensive treatment plan. Assessments described herein include objective and/or self-report measures of physical function, pain, attitude about social support, and sleep quality. Baseline assessments followed by systematic monitoring of the results may give patients and clinicians valuable insight into the effectiveness of the care plan. Empirical evidence from randomized trials with OA patients highlights the effectiveness of cognitive behavioral change strategies for addressing salient concerns for OA (pain control, mobility performance, and sleep quality. Cognitive restructuring can provide patients with renewed power in managing their disease. Cognitive therapy topics discussed presently include: 1 what is OA?, 2 effectiveness of exercise and FITT (frequency, intensity, time, and type principles for OA patients, 3 goal-setting and barriers, and 4 translating to independent care. Woven within the discussion about cognitive therapy are ideas about how the results from baseline assessments and group-mediated dynamics might assist more favorable outcomes. There are a plethora

  6. Novel Dissection of the Central Nervous System to Bridge Gross Anatomy and Neuroscience for an Integrated Medical Curriculum

    Science.gov (United States)

    Hlavac, Rebecca J.; Klaus, Rachel; Betts, Kourtney; Smith, Shilo M.; Stabio, Maureen E.

    2018-01-01

    Medical schools in the United States continue to undergo curricular change, reorganization, and reformation as more schools transition to an integrated curriculum. Anatomy educators must find novel approaches to teach in a way that will bridge multiple disciplines. The cadaveric extraction of the central nervous system (CNS) provides an…

  7. AN INTEGRATED APPROACH FOR LINKED DATA BROWSING

    Directory of Open Access Journals (Sweden)

    W. Beek

    2017-07-01

    Full Text Available The Netherlands' Cadastre, Land Registry and Mapping Agency – in short Kadaster – collects and registers administrative and spatial data on property and the rights involved. Currently, the Kadaster is publishing its geo-spatial data assets as Linked Open Data. The Kadaster manages hundreds of datasets that describe hundreds of millions of geospatial objects, including all Dutch buildings, roads, and forests. The Kadaster exposes this large collection of data to thousands of daily users that operate from within different contexts and that need to be supported in different use cases. Therefore, Kadaster must offer diverse, yet complementary, approaches for browsing and exploring the data it publishes. Specifically, it supports the following paradigms for browsing and exploring its data assets: hierarchical browsing, graph navigation, faceted browsing, and tabular browsing. These paradigms are useful for different tasks, cover different use cases, and are implemented by reusing and/or developing Open Source libraries and applications.

  8. The Social Economy. An Integrating Approach

    Directory of Open Access Journals (Sweden)

    Sorin CACE

    2011-06-01

    Full Text Available The first part of this article analyses the normative approach of the social economy. The social economy is developed in order to create an alternative economic and social space for the people excluded from life necessities and, furthermore, it is not a recent phenomenon; it relies on historical practices which have developed over several centuries in order to meet people’s needs. The social economy institutions from Romania and Greece are then presented. The purpose is to show that clear regulations contribute to the acceptance of the social economy as an alternative and complementary form of producing social welfare. In order to accomplish the normative purposes of meeting life’s necessities and of changing the existing social conditions, the social economy actors must start to think of themselves not as individual agents, but as belonging to a large movement acting within the continuum between the market and state intervention for welfare production.

  9. Nutrigenomics: integrating genomic approaches into nutrition research.

    Science.gov (United States)

    Ferguson, Lynnette R

    2006-01-01

    It has been suggested that the supermarket of today will be the pharmacy of tomorrow. Such statements have been derived from recognition of our increasing ability to optimize nutrition, and maintain a state of good health through longer periods of life. The new field of nutrigenomics, which focuses on the interaction between bioactive dietary components and the genome, recognizes that current nutritional guidelines may be ideal for only a relatively small proportion of the population. There is good evidence that nutrition has significant influences on the expression of genes, and, likewise, genetic variation can have a significant effect on food intake, metabolic response to food, individual nutrient requirements, food safety, and the efficacy of disease-protective dietary factors. For example, a significant number of human studies in various areas are increasing the evidence for interactions between single nucleotide polymorphisms (SNPs) in various genes and the metabolic response to diet, including the risk of obesity. Many of the same genetic polymorphisms and dietary patterns that influence obesity or cardiovascular disease also affect cancer, since overweight individuals are at increased risk of cancer development. The control of food intake is profoundly affected by polymorphisms either in genes encoding taste receptors or in genes encoding a number of peripheral signaling peptides such as insulin, leptin, ghrelin, cholecystokinin, and corresponding receptors. Total dietary intake, and the satiety value of various foods, will profoundly influence the effects of these genes. Identifying key SNPs that are likely to influence the health of an individual provides an approach to understanding and, ultimately, to optimizing nutrition at the population or individual level. Traditional methods for identification of SNPs may involve consideration of individual variants, using methodologies such as restriction fragment length polymorphisms or quantitative real-time PCR

  10. Climate change: what competencies and which medical education and training approaches?

    Science.gov (United States)

    Bell, Erica J

    2010-04-30

    Much research has been devoted to identifying healthcare needs in a climate-changing world. However, while there are now global and national policy statements about the importance of health workforce development for climate change, little has been published about what competencies might be demanded of practitioners in a climate-changing world. In such a context, this debate and discussion paper aims to explore the nature of key competencies and related opportunities for teaching climate change in medical education and training. Particular emphasis is made on preparation for practice in rural and remote regions likely to be greatly affected by climate change. The paper describes what kinds of competencies for climate change might be included in medical education and training. It explores which curricula, teaching, learning and assessment approaches might be involved. Rather than arguing for major changes to medical education and training, this paper explores well established precedents to offer practical suggestions for where a particular kind of literacy--eco-medical literacy--and related competencies could be naturally integrated into existing elements of medical education and training. The health effects of climate change have, generally, not yet been integrated into medical education and training systems. However, the necessary competencies could be taught by building on existing models, best practice and innovative traditions in medicine. Even in crowded curricula, climate change offers an opportunity to reinforce and extend understandings of how interactions between people and place affect health.

  11. Climate change: what competencies and which medical education and training approaches?

    Directory of Open Access Journals (Sweden)

    Bell Erica J

    2010-04-01

    Full Text Available Abstract Background Much research has been devoted to identifying healthcare needs in a climate-changing world. However, while there are now global and national policy statements about the importance of health workforce development for climate change, little has been published about what competencies might be demanded of practitioners in a climate-changing world. In such a context, this debate and discussion paper aims to explore the nature of key competencies and related opportunities for teaching climate change in medical education and training. Particular emphasis is made on preparation for practice in rural and remote regions likely to be greatly affected by climate change. Discussion The paper describes what kinds of competencies for climate change might be included in medical education and training. It explores which curricula, teaching, learning and assessment approaches might be involved. Rather than arguing for major changes to medical education and training, this paper explores well established precedents to offer practical suggestions for where a particular kind of literacy--eco-medical literacy--and related competencies could be naturally integrated into existing elements of medical education and training. Summary The health effects of climate change have, generally, not yet been integrated into medical education and training systems. However, the necessary competencies could be taught by building on existing models, best practice and innovative traditions in medicine. Even in crowded curricula, climate change offers an opportunity to reinforce and extend understandings of how interactions between people and place affect health.

  12. Towards an integrated approach to health and medicine in Africa.

    Science.gov (United States)

    Batisai, Kezia

    2016-12-01

    This article frames the intersections of medicine and humanities as intrinsic to understanding the practice of health care in Africa. Central to this manuscript, which draws on empirical findings on the interplay between HIV and AIDS and alternative medicine in Zimbabwe is the realisation that very limited research has been undertaken to examine 'HIV/AIDS patient behaviour' with respect to choice of therapy on the continent [Bene, M. & Darkoh, M. B. K. (2014). The Constraints of Antiretroviral Uptake in Rural Areas: The Case of Thamaga and Surrounding Villages, Botswana. Journal of Social Aspects of HIV/AIDS, 11(1), 167-177. doi: 10.1080/17290376.2014.972057 ; Chavunduka, G. (1998). Professionalisation of Traditional Medicine in Zimbabwe, Harare, Jongwe Printers; O'Brien, S. & Broom, A. (2014). HIV in (and out of) the Clinic: Biomedicine, Traditional Medicine and Spiritual Healing in Harare. Journal of Social Aspects of HIV/AIDS, 11(1), 94-104. doi: 10.1080/17290376.2014.938102 ]. As such, a social approach to health-seeking behaviour questions how decisions about alternative therapies including herbal remedies, traditional healing and faith healing are made. The paper unpacks the realities around how people living with HIV and AIDS - who span different age groups and profess various religious backgrounds, faced with an insurmountable health challenge against a background of limited resources and no cure for the virus - often experience shifts in health-seeking behaviour. Grappling with seemingly simple questions about 'when, where and how to seek medical attention', the paper provides pointers to therapy choices and health-seeking behaviour; and it serves as a route into deeper and intense healthcare practice explorations. In conclusion, the paper proposes that medicine and the humanities should engage seriously with those social aspects of HIV and AIDS which call for an integrated approach to healthcare practice in Africa. If combined, medicine and the humanities

  13. Integrating Individual and Systems Approaches: Strategic-Behavioral Therapy.

    Science.gov (United States)

    Duncan, Barry L.; Parks, M. Bernadine

    1988-01-01

    Presents a brief model which integrates an individual, cognitive-behavioral approach with a strategic approach to therapy, at both pragmatic and theoretical levels. Justifies the selective use of behavioral frames in strategic therapy in this Strategic-Behavioral model, and offers guidelines for their selective application. Presents and discusses…

  14. Computational Diagnostic: A Novel Approach to View Medical Data.

    Energy Technology Data Exchange (ETDEWEB)

    Mane, K. K. (Ketan Kirtiraj); Börner, K. (Katy)

    2007-01-01

    A transition from traditional paper-based medical records to electronic health record is largely underway. The use of electronic records offers tremendous potential to personalize patient diagnosis and treatment. In this paper, we discuss a computational diagnostic tool that uses digital medical records to help doctors gain better insight about a patient's medical condition. The paper details different interactive features of the tool which offer potential to practice evidence-based medicine and advance patient diagnosis practices. The healthcare industry is a constantly evolving domain. Research from this domain is often translated into better understanding of different medical conditions. This new knowledge often contributes towards improved diagnosis and treatment solutions for patients. But the healthcare industry lags behind to seek immediate benefits of the new knowledge as it still adheres to the traditional paper-based approach to keep track of medical records. However recently we notice a drive that promotes a transition towards electronic health record (EHR). An EHR stores patient medical records in digital format and offers potential to replace the paper health records. Earlier attempts of an EHR replicated the paper layout on the screen, representation of medical history of a patient in a graphical time-series format, interactive visualization with 2D/3D generated images from an imaging device. But an EHR can be much more than just an 'electronic view' of the paper record or a collection of images from an imaging device. In this paper, we present an EHR called 'Computational Diagnostic Tool', that provides a novel computational approach to look at patient medical data. The developed EHR system is knowledge driven and acts as clinical decision support tool. The EHR tool provides two visual views of the medical data. Dynamic interaction with data is supported to help doctors practice evidence-based decisions and make judicious

  15. Recent developments in the path integral approach to anomalies

    International Nuclear Information System (INIS)

    Fujikawa, Kazuo.

    1986-08-01

    After a brief summary of the path integral approach to anomalous identities, some of the recent developments in this approach are discussed. The topics discussed include (i) Construction of the effective action by means of the covariant current, (ii) Gauss law constraint in anomalous gauge theories, (iii) Path integral approach to anomalies in superconformal transformations, (iv) Conformal and ghost number anomalies in string theory in analogy with the instanton calculation, (v) Covariant local Lorentz anomaly and its connection with the mathematical construction of the consistent anomaly. (author)

  16. A cloud-based approach to medical NLP.

    Science.gov (United States)

    Chard, Kyle; Russell, Michael; Lussier, Yves A; Mendonça, Eneida A; Silverstein, Jonathan C

    2011-01-01

    Natural Language Processing (NLP) enables access to deep content embedded in medical texts. To date, NLP has not fulfilled its promise of enabling robust clinical encoding, clinical use, quality improvement, and research. We submit that this is in part due to poor accessibility, scalability, and flexibility of NLP systems. We describe here an approach and system which leverages cloud-based approaches such as virtual machines and Representational State Transfer (REST) to extract, process, synthesize, mine, compare/contrast, explore, and manage medical text data in a flexibly secure and scalable architecture. Available architectures in which our Smntx (pronounced as semantics) system can be deployed include: virtual machines in a HIPAA-protected hospital environment, brought up to run analysis over bulk data and destroyed in a local cloud; a commercial cloud for a large complex multi-institutional trial; and within other architectures such as caGrid, i2b2, or NHIN.

  17. Integration of SNOMED CT into the OpenMRS electronic medical record system framework

    CSIR Research Space (South Africa)

    Gerber, A

    2008-11-01

    Full Text Available Integrating a mechanism to store, retrieve and use clinical data with a system to manage medical records enables better utilisation of medical data and improved healthcare. This poster introduces a research project that aims to extend Open...

  18. High resolution integral holography using Fourier ptychographic approach.

    Science.gov (United States)

    Li, Zhaohui; Zhang, Jianqi; Wang, Xiaorui; Liu, Delian

    2014-12-29

    An innovative approach is proposed for calculating high resolution computer generated integral holograms by using the Fourier Ptychographic (FP) algorithm. The approach initializes a high resolution complex hologram with a random guess, and then stitches together low resolution multi-view images, synthesized from the elemental images captured by integral imaging (II), to recover the high resolution hologram through an iterative retrieval with FP constrains. This paper begins with an analysis of the principle of hologram synthesis from multi-projections, followed by an accurate determination of the constrains required in the Fourier ptychographic integral-holography (FPIH). Next, the procedure of the approach is described in detail. Finally, optical reconstructions are performed and the results are demonstrated. Theoretical analysis and experiments show that our proposed approach can reconstruct 3D scenes with high resolution.

  19. An Integrated Management Approach to Atrial Fibrillation.

    Science.gov (United States)

    Carter, Lindsey; Gardner, Martin; Magee, Kirk; Fearon, Ann; Morgulis, Inna; Doucette, Steve; Sapp, John L; Gray, Chris; Abdelwahab, Amir; Parkash, Ratika

    2016-01-25

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia resulting in mortality and morbidity. Gaps in oral anticoagulation and education of patients regarding AF have been identified as areas that require improvement. A before-and-after study of 433 patients with newly diagnosed AF in the 3 emergency departments in Nova Scotia from January 1, 2011 until January 31, 2014 was performed. The "before" phase underwent the usual-care pathway for AF management; the "after" phase was enrolled in a nurse-run, physician-supervised AF clinic. The primary outcome was a composite of death, cardiovascular hospitalization, and AF-related emergency department visits. A propensity analysis was performed to account for differences in baseline characteristics. A total of 185 patients were enrolled into the usual-care group, and 228 patients were enrolled in the AF clinic group. The mean age was 64±15 years and 44% were women. In a propensity-matched analysis, the primary outcome occurred in 44 (26.2%) patients in the usual-care group and 29 (17.3%) patients in the AF clinic group (odds ratio 0.71; 95% CI [0.59, 1]; P=0.049) at 12 months. Prescription of oral anticoagulation was increased in the CHADS2 ≥2 group (88.4% in the AF clinic versus 58.5% in the usual-care group, Pmanagement approach for the burgeoning population of AF may provide an overall benefit to cardiovascular morbidity and mortality. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  20. A new Gauss quadrature for multicentre integrals over STOs in the Gaussian integral transform approach

    International Nuclear Information System (INIS)

    Bouferguene, Ahmed

    2005-01-01

    When computing multicentre integrals over Slater-type orbitals (STOs) by means of the Shavitt and Karplus Gaussian integral transforms (Shavitt and Karplus 1962 J. Chem. Phys. 36 550), one usually ends up with a multiple integral of the form ∫ 0 1 du ∫ 0 1 dv ...∫ 0 ∞ dz F(u, v, ..., z) (Shavitt and Karplus 1965 J. Chem. Phys. 43 398) in which all the integrals are inter-related. The most widely used approach for computing such an integral is to apply a product of Gauss-Legendre quadratures for the integrals over [0, 1] while the semi-infinite term is evaluated by a special procedure. Although numerous approaches have been developed to accurately perform the integration over [0, ∞) efficiently, it is the aim of this work to add a new tool that could be of some benefit in carrying out the hard task of multicentre integrals over STOs. The new approach relies on a special Gauss quadrature referred to as Gauss-Bessel to accurately evaluate the semi-infinite integral of interest. In this work, emphasis is put on accuracy rather than efficiency since its aim is essentially to bring a proof of concept showing that Gauss-Bessel quadrature can successfully be applied in the context of multicentre integrals over STOs. The obtained accuracy is comparable to that obtained with other methods available in the literature

  1. Managerial process improvement: a lean approach to eliminating medication delivery.

    Science.gov (United States)

    Hussain, Aftab; Stewart, LaShonda M; Rivers, Patrick A; Munchus, George

    2015-01-01

    Statistical evidence shows that medication errors are a major cause of injuries that concerns all health care oganizations. Despite all the efforts to improve the quality of care, the lack of understanding and inability of management to design a robust system that will strategically target those factors is a major cause of distress. The paper aims to discuss these issues. Achieving optimum organizational performance requires two key variables; work process factors and human performance factors. The approach is that healthcare administrators must take in account both variables in designing a strategy to reduce medication errors. However, strategies that will combat such phenomena require that managers and administrators understand the key factors that are causing medication delivery errors. The authors recommend that healthcare organizations implement the Toyota Production System (TPS) combined with human performance improvement (HPI) methodologies to eliminate medication delivery errors in hospitals. Despite all the efforts to improve the quality of care, there continues to be a lack of understanding and the ability of management to design a robust system that will strategically target those factors associated with medication errors. This paper proposes a solution to an ambiguous workflow process using the TPS combined with the HPI system.

  2. Vertically integrated medical education and the readiness for practice of graduates

    NARCIS (Netherlands)

    Wijnen-Meijer, Marjo; ten Cate, Olle; van der Schaaf, Marieke; Burgers, Chantalle; Borleffs, Jan; Harendza, Sigrid

    2015-01-01

    Background: Medical curricula become more and more vertically integrated (VI) to prepare graduates better for clinical practice. VI curricula show early clinical education, integration of biomedical sciences and focus on increasing clinical responsibility levels for trainees. Results of earlier

  3. Implementation of a competency-based medical education approach in public health and epidemiology training of medical students.

    Science.gov (United States)

    Dankner, Rachel; Gabbay, Uri; Leibovici, Leonard; Sadeh, Maya; Sadetzki, Siegal

    2018-02-20

    There is increasing agreement among medical educators regarding the importance of improving the integration between public health and clinical education, understanding and implementation of epidemiological methods, and the ability to critically appraise medical literature. The Sackler School of Medicine at Tel-Aviv University revised its public health and preventive medicine curriculum, during 2013-2014, according to the competency-based medical education (CBME) approach in training medical students. We describe the revised curriculum, which aimed to strengthen competencies in quantitative research methods, epidemiology, public health and preventive medicine, and health service organization and delivery. We report the process undertaken to establish a relevant 6-year longitudinal curriculum and describe its contents, implementation, and continuous assessment and evaluation. Central competencies included: epidemiology and statistics for appraisal of the literature and implementation of research; the application of health promotion principles and health education strategies in disease prevention; the use of an evidence-based approach in clinical and public health decision making; the examination and analysis of disease trends at the population level; and knowledge of the structure of health systems and the role of the physician in these systems. Two new courses, in health promotion, and in public health, were added to the curriculum, and the courses in statistics and epidemiology were joined. Annual evaluation of each course results in continuous revisions of the syllabi as needed, while we continue to monitor the whole curriculum. The described revision in a 6 year-medical school training curriculum addresses the currently identified needs in public health. Ongoing feedback from students, and re-evaluation of syllabus by courses teams are held annually. Analysis of student's written feedbacks and courses evaluations of "before and after" the implementation of this

  4. Implementation of a competency-based medical education approach in public health and epidemiology training of medical students

    Directory of Open Access Journals (Sweden)

    Rachel Dankner

    2018-02-01

    Full Text Available Abstract Background There is increasing agreement among medical educators regarding the importance of improving the integration between public health and clinical education, understanding and implementation of epidemiological methods, and the ability to critically appraise medical literature. The Sackler School of Medicine at Tel-Aviv University revised its public health and preventive medicine curriculum, during 2013–2014, according to the competency-based medical education (CBME approach in training medical students. We describe the revised curriculum, which aimed to strengthen competencies in quantitative research methods, epidemiology, public health and preventive medicine, and health service organization and delivery. Methods We report the process undertaken to establish a relevant 6-year longitudinal curriculum and describe its contents, implementation, and continuous assessment and evaluation. Results Central competencies included: epidemiology and statistics for appraisal of the literature and implementation of research; the application of health promotion principles and health education strategies in disease prevention; the use of an evidence-based approach in clinical and public health decision making; the examination and analysis of disease trends at the population level; and knowledge of the structure of health systems and the role of the physician in these systems. Two new courses, in health promotion, and in public health, were added to the curriculum, and the courses in statistics and epidemiology were joined. Annual evaluation of each course results in continuous revisions of the syllabi as needed, while we continue to monitor the whole curriculum. Conclusions The described revision in a 6 year-medical school training curriculum addresses the currently identified needs in public health. Ongoing feedback from students, and re-evaluation of syllabus by courses teams are held annually. Analysis of student’s written feedbacks

  5. Integrated Giant Magnetoresistance Technology for Approachable Weak Biomagnetic Signal Detections.

    Science.gov (United States)

    Shen, Hui-Min; Hu, Liang; Fu, Xin

    2018-01-07

    With the extensive applications of biomagnetic signals derived from active biological tissue in both clinical diagnoses and human-computer-interaction, there is an increasing need for approachable weak biomagnetic sensing technology. The inherent merits of giant magnetoresistance (GMR) and its high integration with multiple technologies makes it possible to detect weak biomagnetic signals with micron-sized, non-cooled and low-cost sensors, considering that the magnetic field intensity attenuates rapidly with distance. This paper focuses on the state-of-art in integrated GMR technology for approachable biomagnetic sensing from the perspective of discipline fusion between them. The progress in integrated GMR to overcome the challenges in weak biomagnetic signal detection towards high resolution portable applications is addressed. The various strategies for 1/ f noise reduction and sensitivity enhancement in integrated GMR technology for sub-pT biomagnetic signal recording are discussed. In this paper, we review the developments of integrated GMR technology for in vivo/vitro biomagnetic source imaging and demonstrate how integrated GMR can be utilized for biomagnetic field detection. Since the field sensitivity of integrated GMR technology is being pushed to fT/Hz 0.5 with the focused efforts, it is believed that the potential of integrated GMR technology will make it preferred choice in weak biomagnetic signal detection in the future.

  6. How lead consultants approach educational change in postgraduate medical education.

    Science.gov (United States)

    Fokkema, Joanne P I; Westerman, Michiel; Teunissen, Pim W; van der Lee, Nadine; Scherpbier, Albert J J A; van der Vleuten, Cees P M; Dörr, P Joep; Scheele, Fedde

    2012-04-01

      Consultants in charge of postgraduate medical education (PGME) in hospital departments ('lead consultants') are responsible for the implementation of educational change. Although difficulties in innovating in medical education are described in the literature, little is known about how lead consultants approach educational change.   This study was conducted to explore lead consultants' approaches to educational change in specialty training and factors influencing these approaches.   From an interpretative constructivist perspective, we conducted a qualitative exploratory study using semi-structured interviews with a purposive sample of 16 lead consultants in the Netherlands between August 2010 and February 2011. The study design was based on the research questions and notions from corporate business and social psychology about the roles of change managers. Interview transcripts were analysed thematically using template analysis.   The lead consultants described change processes with different stages, including cause, development of content, and the execution and evaluation of change, and used individual change strategies consisting of elements such as ideas, intentions and behaviour. Communication is necessary to the forming of a strategy and the implementation of change, but the nature of communication is influenced by the strategy in use. Lead consultants differed in their degree of awareness of the strategies they used. Factors influencing approaches to change were: knowledge, ideas and beliefs about change; level of reflection; task interpretation; personal style, and department culture.   Most lead consultants showed limited awareness of their own approaches to change. This can lead them to adopt a rigid approach, whereas the ability to adapt strategies to circumstances is considered important to effective change management. Interventions and research should be aimed at enhancing the awareness of lead consultants of approaches to change in PGME.

  7. Integrating Radiology and Anatomy Teaching in Medical Education in the UK--The Evidence, Current Trends, and Future Scope.

    Science.gov (United States)

    Heptonstall, N B; Ali, T; Mankad, K

    2016-04-01

    This review article presents the current evidence of the importance of integrating radiology and anatomy in medical education in the UK, a recommendation by a number of key anatomy, education, and radiology organizations. Current evidence highlights that on average only 5% of total teaching time in medical education is dedicated to radiology. Often, radiology teaching does not adequately fulfill students' learning needs and potentially leaves them underprepared for medical practice. Benefits of integrating radiology and anatomy include improved clinical application of anatomy, an increase in student's interest in anatomy, and ultimately improved radiological interpretation. Various modalities exist for the integration of radiology and anatomy, facilitated by the vast portability of radiological images. It appears that combining radiological resources with traditional anatomy teaching methodology in a blended approach is most beneficial. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  8. Science Teachers’ Pedagogical Content Knowledge and Integrated Approach

    Science.gov (United States)

    Adi Putra, M. J.; Widodo, A.; Sopandi, W.

    2017-09-01

    The integrated approach refers to the stages of pupils’ psychological development. Unfortunately, the competences which are designed into the curriculum is not appropriate with the child development. This Manuscript presents PCK (pedagogical content knowledge) of teachers who teach science content utilizing an integrated approach. The data has been collected by using CoRe, PaP-eR, and interviews from six elementary teachers who teach science. The paper informs that high and stable teacher PCKs have an impact on how teachers present integrated teaching. Because it is influenced by the selection of important content that must be submitted to the students, the depth of the content, the reasons for choosing the teaching procedures and some other things. So for teachers to be able to integrate teaching, they should have a balanced PCK.

  9. Elderly patient refractory to multiple pain medications successfully treated with integrative East–West medicine

    Directory of Open Access Journals (Sweden)

    Bill Tu

    2008-07-01

    Full Text Available Bill Tu, Michael Johnston, Ka-Kit HuiUCLA Center for East–West Medicine, Department of Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USABackground: Polypharmacy is a common and serious problem in the elderly today. Few solutions have been effective in reducing its incidence.Case summary: An 87-year-old female with a history of osteoarthritis and spinal stenosis presented with a five month history of severe right hip pain. She had been seen by multiple specialists and hospitalized many times. During these encounters, she was prescribed a long list of pain medications. However, these medications did not improve her pain and added to her risk of adverse drug events. After exhausting traditional Western medical therapies, she received a referral to the UCLA Center for East–West Medicine. There, clinicians treated her with a nonpharmacological integrative East-West medicine approach that included acupuncture, dry needling of trigger points, and education on self-acupressure. Her pain began improving and she was able to cut back on analgesic use under physician supervision. Ultimately, she improved to the point where she was able to discontinue all of her pain medications. Symptomatic relief was evidenced by improvement in health-related quality of life (HRQOL.Conclusions: This case study suggests that integrative East–West medicine may have the potential to reduce the incidence of polypharmacy in elderly patients presenting with pain conditions and improve their quality of life.Keywords: polypharmacy, pain, osteoarthritis, acupuncture, complementary and alternative medicine, integrative medicine, adverse drug reaction, elderly

  10. Semantic Health Knowledge Graph: Semantic Integration of Heterogeneous Medical Knowledge and Services

    Directory of Open Access Journals (Sweden)

    Longxiang Shi

    2017-01-01

    Full Text Available With the explosion of healthcare information, there has been a tremendous amount of heterogeneous textual medical knowledge (TMK, which plays an essential role in healthcare information systems. Existing works for integrating and utilizing the TMK mainly focus on straightforward connections establishment and pay less attention to make computers interpret and retrieve knowledge correctly and quickly. In this paper, we explore a novel model to organize and integrate the TMK into conceptual graphs. We then employ a framework to automatically retrieve knowledge in knowledge graphs with a high precision. In order to perform reasonable inference on knowledge graphs, we propose a contextual inference pruning algorithm to achieve efficient chain inference. Our algorithm achieves a better inference result with precision and recall of 92% and 96%, respectively, which can avoid most of the meaningless inferences. In addition, we implement two prototypes and provide services, and the results show our approach is practical and effective.

  11. On the integration and standardization of medication error data: taxonomies, terminologies, causes and contributing factors.

    Science.gov (United States)

    Taib, Ibrahim Adham; McIntosh, Andrew Stuart

    2010-12-01

    A reliable database on the causes and contributing factors of medication errors can inform strategies for their prevention. To form a single database from multiple databases requires a process of integration that both maximizes the utility of the new data and minimizes the loss of information. Unfortunately, the terminologies used by different studies and databases may limit integration; therefore, terminologies must be standardized prior to integration. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Taxonomy of Medication Errors was applied to standardize the different terminologies in 11 studies that reported the causes or contributing factors of medication errors. After standardization, 57% of the reported causes and contributing factors were integrated to form a database while 43% were not integrated because the terminologies could not be standardized or were not similar to the taxonomy. This study highlights the challenges to standardizing and integrating databases and the importance of adopting and applying a standardized terminology to record medical errors.

  12. Introduction of Integrative Health and Acupuncture to Pre-Clerkship Medical Students.

    Science.gov (United States)

    Leggit, Jeffrey C

    2014-08-01

    Background: Pain is a common diagnosis in both the civilian and military community. Integrative health practices, such as acupuncture, are often used to treat pain as well as other medical conditions. Medical schools must ensure that their students are aware of what patients are using and how the tools of Integrative Health can be used together with the conventional medical model. Methods: The Uniformed Services University of the Health Sciences (USUHS), The United States' military medical school, is heeding this call in innovative ways. The USUHS uses several means to teach Integrative Health throughout the 4-year medical school experience. A new component, Battlefield Acupuncture, was introduced into the second-year curriculum and was particularly relevant to service personnel. Conclusions: Integrative health modalities introduced to medical students early in their education has been well-received and will prepare them for their medical careers.

  13. Integrating medical imaging analyses through a high-throughput bundled resource imaging system

    Science.gov (United States)

    Covington, Kelsie; Welch, E. Brian; Jeong, Ha-Kyu; Landman, Bennett A.

    2011-03-01

    Exploitation of advanced, PACS-centric image analysis and interpretation pipelines provides well-developed storage, retrieval, and archival capabilities along with state-of-the-art data providence, visualization, and clinical collaboration technologies. However, pursuit of integrated medical imaging analysis through a PACS environment can be limiting in terms of the overhead required to validate, evaluate and integrate emerging research technologies. Herein, we address this challenge through presentation of a high-throughput bundled resource imaging system (HUBRIS) as an extension to the Philips Research Imaging Development Environment (PRIDE). HUBRIS enables PACS-connected medical imaging equipment to invoke tools provided by the Java Imaging Science Toolkit (JIST) so that a medical imaging platform (e.g., a magnetic resonance imaging scanner) can pass images and parameters to a server, which communicates with a grid computing facility to invoke the selected algorithms. Generated images are passed back to the server and subsequently to the imaging platform from which the images can be sent to a PACS. JIST makes use of an open application program interface layer so that research technologies can be implemented in any language capable of communicating through a system shell environment (e.g., Matlab, Java, C/C++, Perl, LISP, etc.). As demonstrated in this proof-of-concept approach, HUBRIS enables evaluation and analysis of emerging technologies within well-developed PACS systems with minimal adaptation of research software, which simplifies evaluation of new technologies in clinical research and provides a more convenient use of PACS technology by imaging scientists.

  14. A Semi-automated Approach to Improve the Efficiency of Medical Imaging Segmentation for Haptic Rendering.

    Science.gov (United States)

    Banerjee, Pat; Hu, Mengqi; Kannan, Rahul; Krishnaswamy, Srinivasan

    2017-08-01

    The Sensimmer platform represents our ongoing research on simultaneous haptics and graphics rendering of 3D models. For simulation of medical and surgical procedures using Sensimmer, 3D models must be obtained from medical imaging data, such as magnetic resonance imaging (MRI) or computed tomography (CT). Image segmentation techniques are used to determine the anatomies of interest from the images. 3D models are obtained from segmentation and their triangle reduction is required for graphics and haptics rendering. This paper focuses on creating 3D models by automating the segmentation of CT images based on the pixel contrast for integrating the interface between Sensimmer and medical imaging devices, using the volumetric approach, Hough transform method, and manual centering method. Hence, automating the process has reduced the segmentation time by 56.35% while maintaining the same accuracy of the output at ±2 voxels.

  15. An interprofessional approach to improving paediatric medication safety

    Directory of Open Access Journals (Sweden)

    Kennedy Neil

    2010-02-01

    Full Text Available Abstract Background Safe drug prescribing and administration are essential elements within undergraduate healthcare curricula, but medication errors, especially in paediatric practice, continue to compromise patient safety. In this area of clinical care, collective responsibility, team working and communication between health professionals have been identified as key elements in safe clinical practice. To date, there is limited research evidence as to how best to deliver teaching and learning of these competencies to practitioners of the future. Methods An interprofessional workshop to facilitate learning of knowledge, core competencies, communication and team working skills in paediatric drug prescribing and administration at undergraduate level was developed and evaluated. The practical, ward-based workshop was delivered to 4th year medical and 3rd year nursing students and evaluated using a pre and post workshop questionnaire with open-ended response questions. Results Following the workshop, students reported an increase in their knowledge and awareness of paediatric medication safety and the causes of medication errors (p Conclusion This study has helped bridge the knowledge-skills gap, demonstrating how an interprofessional approach to drug prescribing and administration has the potential to improve quality and safety within healthcare.

  16. An Integrated Approach for Entry Mission Design and Flight Simulations

    Science.gov (United States)

    Lu, Ping; Rao, Prabhakara

    2004-01-01

    An integrated approach for entry trajectory design, guidance, and simulation is proposed. The key ingredients for this approach are an on-line 3 degree-of-freedom entry trajectory planning algorithm and the entry guidance algorithm that generates the guidance gains automatically. When fully developed, such a tool could enable end-bend entry mission design and simulations in 3DOF and 6DOF mode from de-orbit burn to the TAEM interface and beyond, all in one key stroke. Some preliminary examples of such a capability are presented in this paper that demonstrate the potential of this type of integrated environment.

  17. Nanotechnologies and regenerative medical approaches for space and terrestrial medicine.

    Science.gov (United States)

    Grattoni, Alessandro; Tasciotti, Ennio; Fine, Daniel; Fernandez-Moure, Joseph S; Sakamoto, Jason; Hu, Ye; Weiner, Bradley; Ferrari, Mauro; Parazynski, Scott

    2012-11-01

    One purpose of the International Space Station (ISS) is to explore powerful new areas of biomedical science in microgravity. Recent advances in nanotechnology applied to medicine--what we now refer to as nano-medicine--and regenerative medicine have enormous untapped potential for future space and terrestrial medical applications. Novel means for drug delivery and nanoscale screening tools will one day benefit astronauts venturing to Mars and places beyond, while the space laboratory will foster advances in nanotechnologies for diagnostic and therapeutic tools to help our patients here on Earth. Herein we review a series of nanotechnologies and selected regenerative medical approaches and highlight key areas of ongoing and future investigation that will benefit both space and terrestrial medicine. These studies target significant areas of human disease such as osteoporosis, diabetes, radiation injury, and many others.

  18. An Integrated Approach for Creating Service-Based Interactive Applications

    Science.gov (United States)

    Feldmann, Marius; Janeiro, Jordan; Nestler, Tobias; Hübsch, Gerald; Jugel, Uwe; Preussner, André; Schill, Alexander

    While the implementation of business logic and business processes based on service-oriented architectures is well-understood and covered by existing development approaches, integrated concepts that empower users to exploit the Internet of Services to create complex interactive applications are missing. In this paper, we present an integrated approach that fills this gap. Our approach builds upon service annotations that add meta-information related to user interface generation, service dependencies, and service composition to existing service descriptions. Services can be composed visually to complex interactive applications based on these annotations without the need to write any code. The application code is generated completely from the service composition description. Our approach is able to support heterogeneous target environments ranging from client/server architectures to mobile platforms.

  19. A Key Event Path Analysis Approach for Integrated Systems

    Directory of Open Access Journals (Sweden)

    Jingjing Liao

    2012-01-01

    Full Text Available By studying the key event paths of probabilistic event structure graphs (PESGs, a key event path analysis approach for integrated system models is proposed. According to translation rules concluded from integrated system architecture descriptions, the corresponding PESGs are constructed from the colored Petri Net (CPN models. Then the definitions of cycle event paths, sequence event paths, and key event paths are given. Whereafter based on the statistic results after the simulation of CPN models, key event paths are found out by the sensitive analysis approach. This approach focuses on the logic structures of CPN models, which is reliable and could be the basis of structured analysis for discrete event systems. An example of radar model is given to characterize the application of this approach, and the results are worthy of trust.

  20. Psychiatry in the Harvard Medical School-Cambridge Integrated Clerkship: An Innovative, Year-Long Program

    Science.gov (United States)

    Griswold, Todd; Bullock, Christopher; Gaufberg, Elizabeth; Albanese, Mark; Bonilla, Pedro; Dvorak, Ramona; Epelbaum, Claudia; Givon, Lior; Kueppenbender, Karsten; Joseph, Robert; Boyd, J. Wesley; Shtasel, Derri

    2012-01-01

    Objective: The authors present what is to their knowledge the first description of a model for longitudinal third-year medical student psychiatry education. Method: A longitudinal, integrated psychiatric curriculum was developed, implemented, and sustained within the Harvard Medical School-Cambridge Integrated Clerkship. Curriculum elements…

  1. Computer vision approaches to medical image analysis. Revised papers

    International Nuclear Information System (INIS)

    Beichel, R.R.; Sonka, M.

    2006-01-01

    This book constitutes the thoroughly refereed post proceedings of the international workshop Computer Vision Approaches to Medical Image Analysis, CVAMIA 2006, held in Graz, Austria in May 2006 as a satellite event of the 9th European Conference on Computer Vision, EECV 2006. The 10 revised full papers and 11 revised poster papers presented together with 1 invited talk were carefully reviewed and selected from 38 submissions. The papers are organized in topical sections on clinical applications, image registration, image segmentation and analysis, and the poster session. (orig.)

  2. Integrated Approaches to Occupational Health and Safety: A Systematic Review.

    Science.gov (United States)

    Cooklin, A; Joss, N; Husser, E; Oldenburg, B

    2017-09-01

    The study objective was to conduct a systematic review of the effectiveness of integrated workplace interventions that combine health promotion with occupational health and safety. Electronic databases (n = 8), including PsychInfo and MEDLINE, were systematically searched. Studies included were those that reported on workplace interventions that met the consensus definition of an "integrated approach," published in English, in the scientific literature since 1990. Data extracted were occupation, worksite, country, sample size, intervention targets, follow-up period, and results reported. Quality was assessed according to American College of Occupational and Environmental Medicine Practice Guidelines. Heterogeneity precluded formal meta-analyses. Results were classified according to the outcome(s) assessed into five categories (health promotion, injury prevention, occupational health and safety management, psychosocial, and return-on-investment). Narrative synthesis of outcomes was performed. A total of 31 eligible studies were identified; 23 (74%) were (quasi-)experimental trials. Effective interventions were most of those aimed at improving employee physical or mental health. Less consistent results were reported from integrated interventions targeting occupational health and safety management, injury prevention, or organizational cost savings. Integrated approaches have been posed as comprehensive solutions to complex issues. Empirical evidence, while still emerging, provides some support for this. Continuing investment in, and evaluation of, integrated approaches are worthwhile.

  3. Integrating Six Sigma with total quality management: a case example for measuring medication errors.

    Science.gov (United States)

    Revere, Lee; Black, Ken

    2003-01-01

    Six Sigma is a new management philosophy that seeks a nonexistent error rate. It is ripe for healthcare because many healthcare processes require a near-zero tolerance for mistakes. For most organizations, establishing a Six Sigma program requires significant resources and produces considerable stress. However, in healthcare, management can piggyback Six Sigma onto current total quality management (TQM) efforts so that minimal disruption occurs in the organization. Six Sigma is an extension of the Failure Mode and Effects Analysis that is required by JCAHO; it can easily be integrated into existing quality management efforts. Integrating Six Sigma into the existing TQM program facilitates process improvement through detailed data analysis. A drilled-down approach to root-cause analysis greatly enhances the existing TQM approach. Using the Six Sigma metrics, internal project comparisons facilitate resource allocation while external project comparisons allow for benchmarking. Thus, the application of Six Sigma makes TQM efforts more successful. This article presents a framework for including Six Sigma in an organization's TQM plan while providing a concrete example using medication errors. Using the process defined in this article, healthcare executives can integrate Six Sigma into all of their TQM projects.

  4. Recent changes in Central European landscapes: An integrative ecological approach

    Czech Academy of Sciences Publication Activity Database

    Těšitel, Jan; Kučera, Tomáš

    2005-01-01

    Roč. 24, č. 1 (2005), s. 3-6 ISSN 1335-342X Institutional research plan: CEZ:AV0Z60870520 Keywords : integrative ecological approach * transdisciplinarity * interdisciplinarity * landscape ecology Subject RIV: DO - Wilderness Conservation Impact factor: 0.085, year: 2005

  5. Integration of Task-Based Approaches in a TESOL Course

    Science.gov (United States)

    Chien, Chin-Wen

    2014-01-01

    Under task-based language teaching (TBLT), language learners engage in purposeful, problem-oriented, and outcome-driven tasks that are comparable to real-world activities. This qualitative case study discusses the integration of a task-based approach into a TESOL course in a language teacher education program in Taiwan with regard to 39…

  6. Safety Concepts in Structural Glass Engineering : Towards an Integrated Approach

    NARCIS (Netherlands)

    Bos, F.P.

    2009-01-01

    This dissertation proposes the Integrated Approach to Structural Glass Safety, based on four clearly defined element safety properties, damage sensitivity, relative resistance, redundancy, and fracture mode. The Element Safety Diagram (ESD) is introduced to provide an easy-to-read graphical

  7. The strategic management of hospitals: toward an integrative approach.

    Science.gov (United States)

    Buller, P F; Timpson, L

    1986-01-01

    Evidence indicates that hospital planners do not widely practice strategic management. An integrative approach to strategic management may, however, enable them to better operate in today's increasingly turbulent environment, and hospital strategists can learn from the mistakes of businesses in the corporate sector.

  8. An Integrated Approach to the Teaching of Film and Literature.

    Science.gov (United States)

    Katz, John Stuart

    1969-01-01

    Some of the current approaches to the teaching of film include utilizing the medium as an audio-visual aid, as an attempt to inundate the student with sensations, or in a study of cinema arts and film manufacture. However, the integration of film and literature, in which students can see how each medium functions, seems most viable. Films and…

  9. Integrating GIS Education with Training: A Project-Oriented Approach.

    Science.gov (United States)

    Chen, X. Mara

    1998-01-01

    Argues that hands-on, project-oriented teaching offers an ideal approach to integrating Geographical Information Systems (GIS) education and training. Presents a project-oriented GIS teaching experience as an instructional paradigm that can be used to ensure balance between conceptual GIS learning and software-based hands-on training in…

  10. An integrated approach to cause-of-death analysis

    DEFF Research Database (Denmark)

    Beltrán-Sánchez, Hiram; Preston, Samuel H.; Canudas-Romo, Vladimir

    2008-01-01

    . This integration is accomplished by new formulas that make clearer the interactions among causes of death in determining life expectancy. We apply our approach to changes in life expectancy in the United States between 1970 and 2000. We demonstrate, and explain analytically, the paradox that cancer is responsible...

  11. Integrated analytical approaches towards toxic algal natural products discovery

    DEFF Research Database (Denmark)

    Larsen, Thomas Ostenfeld; Rasmussen, Silas Anselm; Gedsted Andersen, Mikael

    the structures of already known compounds (3). When likely unknown compounds have been identified, we use E-SPE results (4) to predict a fast and optimal purification strategy towards the pure novel compounds for NMR characterization. This presentation will highlight our integrated analytical approaches...

  12. Empathy in Medical Students: Exploring the Impact of a Longitudinal Integrated Clerkship Model

    Science.gov (United States)

    Bergstresser, Kara

    2017-01-01

    Empathy is considered a significant factor in the physician-patient relationship. The current study examined the impact of a Longitudinal Integrated Clerkship (LIC) model on empathy and patient-centered attitude in medical students. Archival data were examined from 186 medical students at a medical college in the mid-Atlantic region of the United…

  13. Integration of Medical Imaging Including Ultrasound into a New Clinical Anatomy Curriculum

    Science.gov (United States)

    Moscova, Michelle; Bryce, Deborah A.; Sindhusake, Doungkamol; Young, Noel

    2015-01-01

    In 2008 a new clinical anatomy curriculum with integrated medical imaging component was introduced into the University of Sydney Medical Program. Medical imaging used for teaching the new curriculum included normal radiography, MRI, CT scans, and ultrasound imaging. These techniques were incorporated into teaching over the first two years of the…

  14. Integrated fluency instruction: Three approaches for working with struggling readers

    Directory of Open Access Journals (Sweden)

    Melanie Kuhn

    2014-11-01

    Full Text Available Effective fluency instruction should focus on reading with understanding, rather than simply reading quickly or expressively. This article outlines three research-based instructional approaches that assist students in developing accurate, automatic word recognition and prosody; at the same time, they ensure learners attend to the text’s meaning as they read. All three approaches integrate instructional principles known to improve reading fluency (modeling, scaffolding, repetition, and extensive opportunity for the reading of connected text. They are also clear and easy-to-implement and have proven successful with struggling readers. As a result, these approaches contribute to learners’ reading success both within and outside of the classroom.

  15. Integrated Fluency Instruction: Three Approaches for Working with Struggling Readers

    Directory of Open Access Journals (Sweden)

    Melanie KUHN

    2014-10-01

    Full Text Available Effective fluency instruction should focus on reading with understanding, rather than simply reading quickly or expressively. This article outlines three research-based instructional approaches that assist students in developing accurate, automatic word recognition and prosody; at the same time, they ensure learners attend to the text’s meaning as they read. All three approaches integrate instructional principles known to improve reading fluency (modeling, scaffolding, repetition, and extensive opportunity for the reading of connected text. They are also clear and easy-to-implement and have proven successful with struggling readers. As a result, these approaches contribute to learners’ reading success both within and outside of the classroom.

  16. Renal masses in children. An integrated imaging approach to diagnosis

    International Nuclear Information System (INIS)

    Wolfson, B.J.; Gainey, M.A.; Faerber, E.N.; Capitanio, M.A.

    1985-01-01

    In view of the continuing technologic advancements in the development and availability of diagnostic imaging modalities, it is appropriate to assess periodically the currently accepted approaches to the evaluation of renal masses in children. The roles, advantages, and disadvantages of plain film, intravenous urography, ultrasonography, radionuclide scintigraphy, computed tomography, angiography, and magnetic resonance imaging in the approach to the evaluation of renal masses in children are discussed. An integrated imaging approach that provides the most accurate and necessary information for diagnosis and treatment is recommended. 70 references

  17. Integration of the e-Learning into the medical university curricula.

    Science.gov (United States)

    Rusnakova, V; Bacharova, L; Simo, J; Krcmeryova, T; Finka, M; Kovac, R

    2012-01-01

    The aim of this contribution was to present the e-Learning introduction in the Slovak Medical University (SMU) with a focus on the implementation phase of the two blended courses - Healthcare Quality and Healthcare Professionals' Ethics. The introduction of the e-Learning was realized during the period 2008-2009 in the partnership of SMU and IBM Company, following strictly the project management approach. The development of the e-module beta-versions was evaluated by the modules' authors using a structured interview. In a consequent pilot testing, the blended courses were evaluated by 23 students of the bachelor program in Rescue health care, and by 61 public health students at the master level program, respectively, using the standardized questionnaires. The tangible results included the documented SMU strategy for the e-Learning integration, six e-Learning modules and evaluation results. The authors' evaluation showed high scores for the experience in collaboration with IBM, as well as for the experience with the LMS environment. The students' evaluation showed a high acceptance of the e-Learning by both part-time and full-time students. The access to Internet was not recognized as a serious barrier. The first experience with the integration of the e-Learning into the curricula of the Slovak Medical University showed the advantage of the systematic approach. The experience with developing the strategy in an interdisciplinary/ intercultural team, the knowledge about specific characteristics of distance learning by the involved SMU staff, and the know-how and skills represented the important benefits. It was demonstrated that the blended learning is recommended as optimal for the education in medical environment (Tab. 4, Fig. 1, Ref. 22).

  18. Science of Integrated Approaches to Natural Resources Management

    Science.gov (United States)

    Tengberg, Anna; Valencia, Sandra

    2017-04-01

    To meet multiple environmental objectives, integrated programming is becoming increasingly important for the Global Environmental Facility (GEF), the financial mechanism of the multilateral environmental agreements, including the United Nations Convention to Combat Desertification (UNCCD). Integration of multiple environmental, social and economic objectives also contributes to the achievement of the Sustainable Development Goals (SDGs) in a timely and cost-effective way. However, integration is often not well defined. This paper therefore focuses on identifying key aspects of integration and assessing their implementation in natural resources management (NRM) projects. To that end, we draw on systems thinking literature, and carry out an analysis of a random sample of GEF integrated projects and in-depth case studies demonstrating lessons learned and good practices in addressing land degradation and other NRM challenges. We identify numerous challenges and opportunities of integrated approaches that need to be addressed in order to maximise the catalytic impact of the GEF during problem diagnosis, project design, implementation and governance. We highlight the need for projects to identify clearer system boundaries and main feedback mechanisms within those boundaries, in order to effectively address drivers of environmental change. We propose a theory of change for Integrated Natural Resources Management (INRM) projects, where short-term environmental and socio-economic benefits will first accrue at the local level. Implementation of improved INRM technologies and practices at the local level can be extended through spatial planning, strengthening of innovation systems, and financing and incentive mechanisms at the watershed and/or landscape/seascape level to sustain and enhance ecosystem services at larger scales and longer time spans. We conclude that the evolving scientific understanding of factors influencing social, technical and institutional innovations and

  19. How can design approaches be integrated into entrepreneurship education?

    DEFF Research Database (Denmark)

    Færgemann, Helle Meibom; Nørgård, Rikke Toft; Robinson, Sarah

    Questions we care about: When educating students through entrepreneurship we are interested in how can design approaches and processes be integrated into Entrepreneurship Education and what effect does this have on entrepreneurial learning? Approach: This is a conceptual paper which draws on data...... integrates divergent and convergent sub processes from the design sphere into the general effectual and causal processes of entrepreneurship education. The hope is to lessen – not eliminate -the frustration level among the students in the uncertain effectuation process by providing the students with more...... from a classic entrepreneurship course (mix of for- and through-approach) as well as a classic design course. Furthermore data from the iterative development of an entrepreneurship course with substantial design elements is a key data source. Overall, products and processes in the course have been...

  20. Anatomy as the Backbone of an Integrated First Year Medical Curriculum: Design and Implementation

    Science.gov (United States)

    Klement, Brenda J.; Paulsen, Douglas F.; Wineski, Lawrence E.

    2011-01-01

    Morehouse School of Medicine chose to restructure its first year medical curriculum in 2005. The anatomy faculty had prior experience in integrating courses, stemming from the successful integration of individual anatomical sciences courses into a single course called Human Morphology. The integration process was expanded to include the other…

  1. Graph-based sequence annotation using a data integration approach.

    Science.gov (United States)

    Pesch, Robert; Lysenko, Artem; Hindle, Matthew; Hassani-Pak, Keywan; Thiele, Ralf; Rawlings, Christopher; Köhler, Jacob; Taubert, Jan

    2008-08-25

    The automated annotation of data from high throughput sequencing and genomics experiments is a significant challenge for bioinformatics. Most current approaches rely on sequential pipelines of gene finding and gene function prediction methods that annotate a gene with information from different reference data sources. Each function prediction method contributes evidence supporting a functional assignment. Such approaches generally ignore the links between the information in the reference datasets. These links, however, are valuable for assessing the plausibility of a function assignment and can be used to evaluate the confidence in a prediction. We are working towards a novel annotation system that uses the network of information supporting the function assignment to enrich the annotation process for use by expert curators and predicting the function of previously unannotated genes. In this paper we describe our success in the first stages of this development. We present the data integration steps that are needed to create the core database of integrated reference databases (UniProt, PFAM, PDB, GO and the pathway database Ara-Cyc) which has been established in the ONDEX data integration system. We also present a comparison between different methods for integration of GO terms as part of the function assignment pipeline and discuss the consequences of this analysis for improving the accuracy of gene function annotation. The methods and algorithms presented in this publication are an integral part of the ONDEX system which is freely available from http://ondex.sf.net/.

  2. SPATIAL DATA INTEGRATION USING ONTOLOGY-BASED APPROACH

    Directory of Open Access Journals (Sweden)

    S. Hasani

    2015-12-01

    Full Text Available In today's world, the necessity for spatial data for various organizations is becoming so crucial that many of these organizations have begun to produce spatial data for that purpose. In some circumstances, the need to obtain real time integrated data requires sustainable mechanism to process real-time integration. Case in point, the disater management situations that requires obtaining real time data from various sources of information. One of the problematic challenges in the mentioned situation is the high degree of heterogeneity between different organizations data. To solve this issue, we introduce an ontology-based method to provide sharing and integration capabilities for the existing databases. In addition to resolving semantic heterogeneity, better access to information is also provided by our proposed method. Our approach is consisted of three steps, the first step is identification of the object in a relational database, then the semantic relationships between them are modelled and subsequently, the ontology of each database is created. In a second step, the relative ontology will be inserted into the database and the relationship of each class of ontology will be inserted into the new created column in database tables. Last step is consisted of a platform based on service-oriented architecture, which allows integration of data. This is done by using the concept of ontology mapping. The proposed approach, in addition to being fast and low cost, makes the process of data integration easy and the data remains unchanged and thus takes advantage of the legacy application provided.

  3. A twistorial approach to integrability in N = 4 SYM

    Energy Technology Data Exchange (ETDEWEB)

    Koster, Laura; Mitev, Vladimir; Staudacher, Matthias [Institut fuer Mathematik, Institut fuer Physik und IRIS Adlershof, Humboldt-Universitaet Berlin (Germany)

    2015-02-01

    While the achievements in the study of N = 4 SYM Super Yang-Mills through the application of integrability are impressive, the precise origins of the exact solvability remain shrouded in mystery. In this note, we propose that viewing the problem through the lens of twistor theory should help to clarify the reasons for integrability. We illustrate the power of this approach by rederiving the model's one-loop spin chain dilatation operator in the SO(6) sector. (copyright 2015 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  4. A design approach for integrating thermoelectric devices using topology optimization

    International Nuclear Information System (INIS)

    Soprani, S.; Haertel, J.H.K.; Lazarov, B.S.; Sigmund, O.; Engelbrecht, K.

    2016-01-01

    Highlights: • The integration of a thermoelectric (TE) cooler into a robotic tool is optimized. • Topology optimization is suggested as design tool for TE integrated systems. • A 3D optimization technique using temperature dependent TE properties is presented. • The sensitivity of the optimization process to the boundary conditions is studied. • A working prototype is constructed and compared to the model results. - Abstract: Efficient operation of thermoelectric devices strongly relies on the thermal integration into the energy conversion system in which they operate. Effective thermal integration reduces the temperature differences between the thermoelectric module and its thermal reservoirs, allowing the system to operate more efficiently. This work proposes and experimentally demonstrates a topology optimization approach as a design tool for efficient integration of thermoelectric modules into systems with specific design constraints. The approach allows thermal layout optimization of thermoelectric systems for different operating conditions and objective functions, such as temperature span, efficiency, and power recovery rate. As a specific application, the integration of a thermoelectric cooler into the electronics section of a downhole oil well intervention tool is investigated, with the objective of minimizing the temperature of the cooled electronics. Several challenges are addressed: ensuring effective heat transfer from the load, minimizing the thermal resistances within the integrated system, maximizing the thermal protection of the cooled zone, and enhancing the conduction of the rejected heat to the oil well. The design method incorporates temperature dependent properties of the thermoelectric device and other materials. The 3D topology optimization model developed in this work was used to design a thermoelectric system, complete with insulation and heat sink, that was produced and tested. Good agreement between experimental results and

  5. Dynamic integration of residential building design and green energies : the Bireth approach : building integrated renewable energy total harvest approach

    Energy Technology Data Exchange (ETDEWEB)

    Cheung, K.P. [Hong Kong Univ., Hong Kong (China). Dept. of Architecture; Luk, C.L.P. [Chu Hai College of Higher Education, Hong Kong (China). Dept. of Architecture; Wong, S.T. [Hong Kong Univ., Hong Kong (China). Div. of Arts and Humanities, SPACE; Chung, S.L.; Fung, K.S.; Leung, M.F. [Hong Kong Inst. of Vocational Education, Hong Kong (China)

    2006-07-01

    Renewable energy sources that are commonly used in buildings include solar energy, wind energy and rainwater collection. High quality environmentally responsive residential buildings are designed to provide good insulation in winter and solar shading in summer. However, this study demonstrated that the green energy design in residential buildings is not usually well integrated. For example, windows with clear double or triple glazed glass, allow good penetration of sunlight during the day in winter, but are not further dynamically insulated for when the sun goes down to avoid heat loss from the building. Additionally, good solar static shading devices often block much needed daylight on cloudy winter days. These examples emphasize the lack of an integrated approach to gain the best advantage of green energies and to minimize energy costs in residential buildings. This study addressed issues facing the integrated approach with particular reference to the design of a small residential building in rural Beijing. The design included a new approach for interpreting a traditional Beijing court yard house in the modern Beijing rural context, while integrating multi-responding innovative green energy applications derived from first principles. This paper also presented a proposal for a village house in Hong Kong to harvest as much renewable energies as possible, primarily wind energy and solar energy, that come into contact with the building. The purpose was to work towards a renewable energy approach for buildings, namely the Bireth approach, which will benefit practically all houses by making them zero energy houses. The paper described the feasibility of integrating renewable energies in buildings to fulfill performance requirements such improving ventilation, providing warm interiors, drying clothes, or storing solar and wind energies into power batteries. The challenges facing the development of a proposed micro solar hot air turbine were also presented. 15 refs., 6

  6. An integrated approach towards future ballistic neck protection materials selection.

    Science.gov (United States)

    Breeze, John; Helliker, Mark; Carr, Debra J

    2013-05-01

    Ballistic protection for the neck has historically taken the form of collars attached to the ballistic vest (removable or fixed), but other approaches, including the development of prototypes incorporating ballistic material into the collar of an under body armour shirt, are now being investigated. Current neck collars incorporate the same ballistic protective fabrics as the soft armour of the remaining vest, reflecting how ballistic protective performance alone has historically been perceived as the most important property for neck protection. However, the neck has fundamental differences from the thorax in terms of anatomical vulnerability, flexibility and equipment integration, necessitating a separate solution from the thorax in terms of optimal materials selection. An integrated approach towards the selection of the most appropriate combination of materials to be used for each of the two potential designs of future neck protection has been developed. This approach requires evaluation of the properties of each potential material in addition to ballistic performance alone, including flexibility, mass, wear resistance and thermal burden. The aim of this article is to provide readers with an overview of this integrated approach towards ballistic materials selection and an update of its current progress in the development of future ballistic neck protection.

  7. Care concept in medical and nursing students’ descriptions – Philosophical approach and implications for medical education

    Directory of Open Access Journals (Sweden)

    Beata Dobrowolska

    2014-11-01

    Full Text Available [b]introduction.[/b] Care is seen as something that is peculiar to the medical sciences but its meaning and status for physicians and nurses differs. objectives. The aim of this research was to learn how nursing and medical students understand and define care, and how their definition and views on their practice of caring change as they advance through their studies. [b]material and methods[/b]. The study was conducted among two groups of students: before and after their first practicum (n=102. Analysis of the students’ answers was carried out using Colaizzi’s phenomenological descriptive methodology, which means that a qualitative approach was used. [b]results[/b]. The qualitative analysis shows that the medical and nursing students define care in the same way, using 9 main categories: compassion, commitment, competence, confidence, conscience, communication, patience, courage and support. The nursing students viewed their caring to be within both practical and emotional dimensions and this was a core feature of their identity as nurses. Medical students, on the other hand, viewed the practical dimension of care as an additional activity. All the students in the study underlined the importance of having time to care and showed that, for them, ‘time’ in this context has a moral meaning. What was interesting to the research team centered on the initial attitudes to ‘caring’ from both medical and nursing students. [b]conclusions[/b]. We found that students of both nursing and medicine do not begin their studies with different attitudes and concepts of care. However, after their initial exposure to practical placements a process begins which forges different identities around the concept of care. This implies trends in the division of professional roles during their initial education.

  8. Nurses' clinical reasoning practices that support safe medication administration: An integrative review of the literature.

    Science.gov (United States)

    Rohde, Emily; Domm, Elizabeth

    2018-02-01

    To review the current literature about nurses' clinical reasoning practices that support safe medication administration. The literature about medication administration frequently focuses on avoiding medication errors. Nurses' clinical reasoning used during medication administration to maintain medication safety receives less attention in the literature. As healthcare professionals, nurses work closely with patients, assessing and intervening to promote mediation safety prior to, during and after medication administration. They also provide discharge teaching about using medication safely. Nurses' clinical reasoning and practices that support medication safety are often invisible when the focus is medication errors avoidance. An integrative literature review was guided by Whittemore and Knafl's (Journal of Advanced Nursing, 5, 2005 and 546) five-stage review of the 11 articles that met review criteria. This review is modelled after Gaffney et al.'s (Journal of Clinical Nursing, 25, 2016 and 906) integrative review on medical error recovery. Health databases were accessed and systematically searched for research reporting nurses' clinical reasoning practices that supported safe medication administration. The level and quality of evidence of the included research articles were assessed using The Johns Hopkins Nursing Evidence-Based Practice Rating Scale©. Nurses have a central role in safe medication administration, including but not limited to risk awareness about the potential for medication errors. Nurses assess patients and their medication and use knowledge and clinical reasoning to administer medication safely. Results indicated nurses' use of clinical reasoning to maintain safe medication administration was inadequately articulated in 10 of 11 studies reviewed. Nurses are primarily responsible for safe medication administration. Nurses draw from their foundational knowledge of patient conditions and organisational processes and use clinical reasoning that

  9. Advancing medical education: connecting interprofessional collaboration and education opportunities with integrative medicine initiatives to build shared learning.

    Science.gov (United States)

    Templeman, Kate; Robinson, Anske; McKenna, Lisa

    2016-12-01

    BackgroundImproved teamwork between conventional and complementary medicine (CM) practitioners is indicated to achieve effective healthcare. However, little is known about interprofessional collaboration and education in the context of integrative medicine (IM). MethodsThis paper reports the findings from a constructivist-grounded theory method study that explored and highlighted Australian medical students' experiences and opportunities for linking interprofessional collaboration and learning in the context of IM. Following ethical approval, in-depth semi-structured interviews were conducted with 30 medical students from 10 medical education faculties across Australian universities. Results Medical students recognised the importance of interprofessional teamwork between general medical practitioners and CM professionals in patient care and described perspectives of shared responsibilities, profession-specific responsibilities, and collaborative approaches within IM. While students identified that limited interprofessional collaboration currently occurred in the medical curriculum, interprofessional education was considered a means of increasing communication and collaboration between healthcare professionals, helping coordinate effective patient care, and understanding each healthcare team members' professional role and value. Conclusions The findings suggest that medical curricula should include opportunities for medical students to develop required skills, behaviours, and attitudes for interprofessional collaboration and interprofessional education within the context of IM. While this is a qualitative study that reflects theoretical saturation from a selected cohort of medical students, the results also point to the importance of including CM professionals within interprofessional collaboration, thus contributing to more person-centred care.

  10. Path-integral approach to resonant electron-molecule scattering

    International Nuclear Information System (INIS)

    Winterstetter, M.; Domcke, W.

    1993-01-01

    A path-integral formulation of resonant electron-molecule scattering is developed within the framework of the projection-operator formalism of scattering theory. The formation and decay of resonances is treated in real time as a quantum-mechanical electronic-tunneling process, modified by the coupling of the electronic motion with the nuclear degrees of freedom. It is shown that the electronic continuum can be summed over in the path-integral formulation, resulting formally in the path integral for an effective two-state system with coupling to vibrations. The harmonic-oscillator approximation is adopted for the vibrational motion in the present work. Approximation methods are introduced which render the numerical evaluation of the sum over paths feasible for up to ∼10 3 elementary time slices. The theory is numerically realized for simple but nontrivial models representing the 2 Π g d-wave shape resonance in e - +N 2 collisions and the 2 Σ u + p-wave shape resonance in e - +H 2 collisions, respectively. The accuracy of the path-integral results is assessed by comparison with exact numerical reference data for these models. The essential virtue of the path-integral approach is the fact that the computational effort scales at most linearly with the number of vibrational degrees of freedom. The path-integral method is thus well suited to treat electron collisions with polyatomic molecules and molecular aggregates

  11. Pharmacotherapy of attention-deficit/hyperactivity disorder: nonstimulant medication approaches.

    Science.gov (United States)

    Mohammadi, Mohammad Reza; Akhondzadeh, Shahin

    2007-02-01

    Attention-deficit/hyperactivity disorder (ADHD) is one of the most common chronic health conditions and mental disorders affecting school-aged children. Prevalence with a conservative estimate is reported to be 3-5% of this population. Boys are approximately three-times more likely to be diagnosed than girls. The diagnosis refers to a family of related chronic neurobiological disorders that interfere with an individual's capacity to regulate activity level, inhibit behavior and attend to tasks in developmentally appropriate ways. Signs and symptoms of ADHD are typically present during the preschool period or in the early elementary school years, and the diagnosis requires that difficulties were present at or before age 7 years and create problems or impairment in at least two areas of the child's life (e.g., at school, on the playground, on the bus, at home or socially with peers). Stimulants are the first-line medication in the psychopharmacological treatment of ADHD. Between 10 and 30% of those affected with ADHD may not respond to stimulants or may not be able to tolerate associated side effects, such as appetite suppression, sleep disturbance, mood difficulties or exacerbation of comorbid tic disorders. In such instances, or when families are unwilling to consider a stimulant, nonstimulant medications may be appealing. Several nonstimulant medications that affect noradrenergic and/or dopaminergic pathways have demonstrated efficacy in the treatment of ADHD, although effect sizes are comparable with methylphenidate, fewer data have accumulated regarding the safety profile of nonstimulants in general. This review focuses on etiology, assessment and treatment of ADHD, in particular alternative treatment approaches with various nonstimulant agents, especially atomoxetine.

  12. Babenko’s Approach to Abel’s Integral Equations

    Directory of Open Access Journals (Sweden)

    Chenkuan Li

    2018-03-01

    Full Text Available The goal of this paper is to investigate the following Abel’s integral equation of the second kind: y ( t + λ Γ ( α ∫ 0 t ( t − τ α − 1 y ( τ d τ = f ( t , ( t > 0 and its variants by fractional calculus. Applying Babenko’s approach and fractional integrals, we provide a general method for solving Abel’s integral equation and others with a demonstration of different types of examples by showing convergence of series. In particular, we extend this equation to a distributional space for any arbitrary α ∈ R by fractional operations of generalized functions for the first time and obtain several new and interesting results that cannot be realized in the classical sense or by the Laplace transform.

  13. Teaching psychodynamic psychotherapy to psychiatric residents: an integrated approach.

    Science.gov (United States)

    Gastelum, Emily; Douglas, Carolyn J; Cabaniss, Deborah L

    2013-03-01

    There is enduring controversy in our field regarding the place for supportive interventions in psychodynamic psychotherapy. This controversy is reflected in the differing ways in which psychodynamic psychotherapy has been conceptualized and taught in psychiatric residency training programs. The authors propose an "integrated" approach for teaching psychodynamic psychotherapy to trainees. In the integrated model, psychodynamic psychotherapy is conceptualized as a form of therapy designed to (a) uncover unconscious elements that influence thoughts, feelings, and behavior, and (b) support weakened psychological function. Using this model, residents learning psychodynamic psychotherapy are taught both uncovering and supporting techniques side by side in one course with specific guidelines for assessing when to use one set of interventions or the other. Teaching psychodynamic psychotherapy to residents in this integrated way prepares them to become skilled clinicians who are able to move fluidly from supporting to uncovering in a pragmatic and flexible manner, matched to the particular moment-to-moment needs of the individual patient.

  14. Systems Approaches: A Global and Historical Perspective on Integrative Medicine

    Science.gov (United States)

    2012-01-01

    The globalization of healing systems is a dance of cultural awareness and cultural dominance that has arisen throughout history. With the development of greater communication and interest in whole-systems approaches to healing, the opportunity for the development of a global perspective on healing has emerged with new life force. The birth of integrative holistic healing systems in the West, such as naturopathic, homeopathic, anthroposophic, integral and functional medicine, and others, echoes the ocean of wisdom present in traditional healing systems, such as traditional Chinese medicine (TCM) and Ayurveda. In working to integrate the lessons from these systems, we see the inextricable link between man and the natural world, we work to understand the root cause of disease, we focus on the whole person to return balance, and we use empiric observation in large populations over time to grasp the interrelationships inherent in the whole-systems view of illness and wellness. PMID:24278794

  15. Integrated Transport Planning Framework Involving Combined Utility Regret Approach

    DEFF Research Database (Denmark)

    Wang, Yang; Monzon, Andres; Di Ciommo, Floridea

    2014-01-01

    in a framework for integrated transport planning. The framework consisted of a two-round Delphi survey, integrated land use and transport model for Madrid, and multicriteria analysis. Results show that (a) the regret-based ranking has a similar mean but larger variance than the utility-based ranking does, (b......Sustainable transport planning requires an integrated approach involving strategic planning, impact analysis, and multicriteria evaluation. This study aimed at relaxing the utility-based decision-making assumption by newly embedding anticipated-regret and combined utility regret decision mechanisms......-based multicriteria analyses result in different rankings of policy packages, and (e) the combined utility regret ranking is more informative compared with the utility-based or the regret-based ranking....

  16. Drugs of Abuse and Addiction: An integrated approach to teaching.

    Science.gov (United States)

    Miller, Lindsey N; Mercer, Susan L

    2017-05-01

    To describe the design, implementation, and student perceptions of a Drugs of Abuse and Addiction elective course utilizing an integrated teaching model. Third-year pharmacy students enrolled in the two credit hour elective. Teaching methodology included didactic lecture, journal club, simulated addiction assignment with reflection, debates, external speakers, site visit to a residential drug court program and research paper with presentation. A course objective survey was administered upon course completion. All students strongly agreed that having science- and clinical-based faculty members develop and deliver course content was beneficial. Additionally, all students agree to strongly agree that their research project helped them integrate and comprehend the science and practice surrounding drugs of abuse and addiction. Students enjoyed an integrated teaching approach and multiple teaching methodologies leading to increased engagement and enhancement of student learning. Course enrollment was beneficial for personalized learning, but limited student perspective. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. MEDICAL REHABILITATION OF CHILDREN AFTER NEUROINFECTIONS: ORGANIZATIONAL APPROACHES

    Directory of Open Access Journals (Sweden)

    I. G. Samoilova

    2017-01-01

    Full Text Available The analysis of organizational technologies of medical rehabilitation of children, who have undergone neuroinfections and children with organic damage of the nervous system is carried out. A comprehensive approach is recommended for the implementation of rehabilitation measures. It is included in the early recovery period of the course of neuroinfections, in accordance with the profile and severity of the infectious process, according to the individual rehabilitation program, to minimize the negative consequences of infections on the central nervous system in children. The role of a multidisciplinary team in the formation of a rehabilitation program based on an objective assessment of the rehabilitation potential is demonstrated. An algorithm aimed at providing rehabilitation measures for children with neuroinfections. 

  18. The terrorist threat nuclear, radiological, biological, chemical - a medical approach

    International Nuclear Information System (INIS)

    Revel, M.C. de; Gourmelon, M.C.S.; Vidal, P.C.; Renaudeau, P.C.S.

    2005-01-01

    Since September 11, 2001, the fear of a large scale nuclear, biological and/or chemical terrorism is taken again into consideration at the highest level of national policies of risk prevention. The advent of international terrorism implies a cooperation between the military defense and the civil defense. The nuclear, radiological, biological and chemical (NRBC) experts of the health service of army and of civil defense will have to work together in case of major terror attack. This book presents this cooperation between civil and military experts in the NRBC domain: risk analysis, national defense plans, crisis management, syndromes and treatments. The different aspects linked with the use of nuclear, biological and chemical weapons are analyzed by the best experts from French medical and research institutes. All topics of each NRBC domain are approached: historical, basic, diagnostic, therapeutic and preventive. (J.S.)

  19. An Integrated Approach to Indoor and Outdoor Localization

    Science.gov (United States)

    2017-04-17

    AFRL-AFOSR-VA-TR-2017-0087 An Integrated Approach to Indoor and Outdoor Localization Kannan Ramchandran REGENTS OF THE UNIVERSITY OF CALIFORNIA THE...2150 SHATTUCK AVE RM 313 BERKELEY, CA 94704 04/17/2017 Final Report DISTRIBUTION A: Distribution approved for public release. Air Force Research...Laboratory AF Office Of Scientific Research (AFOSR)/RTB1 4/21/2017https://livelink.ebs.afrl.af.mil/livelink/llisapi.dll a. REPORT Unclassified b. ABSTRACT

  20. Graph-based sequence annotation using a data integration approach

    Directory of Open Access Journals (Sweden)

    Pesch Robert

    2008-06-01

    Full Text Available The automated annotation of data from high throughput sequencing and genomics experiments is a significant challenge for bioinformatics. Most current approaches rely on sequential pipelines of gene finding and gene function prediction methods that annotate a gene with information from different reference data sources. Each function prediction method contributes evidence supporting a functional assignment. Such approaches generally ignore the links between the information in the reference datasets. These links, however, are valuable for assessing the plausibility of a function assignment and can be used to evaluate the confidence in a prediction. We are working towards a novel annotation system that uses the network of information supporting the function assignment to enrich the annotation process for use by expert curators and predicting the function of previously unannotated genes. In this paper we describe our success in the first stages of this development. We present the data integration steps that are needed to create the core database of integrated reference databases (UniProt, PFAM, PDB, GO and the pathway database Ara- Cyc which has been established in the ONDEX data integration system. We also present a comparison between different methods for integration of GO terms as part of the function assignment pipeline and discuss the consequences of this analysis for improving the accuracy of gene function annotation.

  1. Workplace mental health: developing an integrated intervention approach

    Science.gov (United States)

    2014-01-01

    Background Mental health problems are prevalent and costly in working populations. Workplace interventions to address common mental health problems have evolved relatively independently along three main threads or disciplinary traditions: medicine, public health, and psychology. In this Debate piece, we argue that these three threads need to be integrated to optimise the prevention of mental health problems in working populations. Discussion To realise the greatest population mental health benefits, workplace mental health intervention needs to comprehensively 1) protect mental health by reducing work–related risk factors for mental health problems; 2) promote mental health by developing the positive aspects of work as well as worker strengths and positive capacities; and 3) address mental health problems among working people regardless of cause. We outline the evidence supporting such an integrated intervention approach and consider the research agenda and policy developments needed to move towards this goal, and propose the notion of integrated workplace mental health literacy. Summary An integrated approach to workplace mental health combines the strengths of medicine, public health, and psychology, and has the potential to optimise both the prevention and management of mental health problems in the workplace. PMID:24884425

  2. Workplace mental health: developing an integrated intervention approach.

    Science.gov (United States)

    LaMontagne, Anthony D; Martin, Angela; Page, Kathryn M; Reavley, Nicola J; Noblet, Andrew J; Milner, Allison J; Keegel, Tessa; Smith, Peter M

    2014-05-09

    Mental health problems are prevalent and costly in working populations. Workplace interventions to address common mental health problems have evolved relatively independently along three main threads or disciplinary traditions: medicine, public health, and psychology. In this Debate piece, we argue that these three threads need to be integrated to optimise the prevention of mental health problems in working populations. To realise the greatest population mental health benefits, workplace mental health intervention needs to comprehensively 1) protect mental health by reducing work-related risk factors for mental health problems; 2) promote mental health by developing the positive aspects of work as well as worker strengths and positive capacities; and 3) address mental health problems among working people regardless of cause. We outline the evidence supporting such an integrated intervention approach and consider the research agenda and policy developments needed to move towards this goal, and propose the notion of integrated workplace mental health literacy. An integrated approach to workplace mental health combines the strengths of medicine, public health, and psychology, and has the potential to optimise both the prevention and management of mental health problems in the workplace.

  3. Academic medicine amenities unit: developing a model to integrate academic medical care with luxury hotel services.

    Science.gov (United States)

    Kennedy, David W; Kagan, Sarah H; Abramson, Kelly Brennen; Boberick, Cheryl; Kaiser, Larry R

    2009-02-01

    The interface between established values of academic medicine and the trend toward inpatient amenities units requires close examination. Opinions of such units can be polarized, reflecting traditional reservations about the ethical dilemma of offering exclusive services only to an elite patient group. An amenities unit was developed at the University of Pennsylvania Health System in 2007, using an approach that integrated academic medicine values with the benefits of philanthropy and service excellence to make amenities unit services available to all patients. Given inherent internal political concerns, a broadly based steering committee of academic and hospital leadership was developed. An academically appropriate model was conceived, anchored by four principles: (1) integration of academic values, (2) interdisciplinary senior leadership, (3) service excellence, and (4) recalibrated occupancy expectations based on multiple revenue streams. Foremost is ensuring the same health care is afforded all patients throughout the hospital, thereby overcoming ethical challenges and optimizing teaching experiences. Service excellence frames the service ethic for all staff, and this, in addition to luxury hotel-style amenities, differentiates the style and feel of the unit from others in the hospital. Recalibrated occupancy creates program viability given revenue streams redefined to encompass gifts and patient revenue, including both reimbursement and self-pay. The medical-surgical amenities patient-care unit has enjoyed a successful first year and a growing stream of returning patients and admitting physicians. Implications for other academic medical centers include opportunities to extrapolate service excellence throughout the hospital and to cultivate philanthropy to benefit services throughout the medical center.

  4. Reduced integral order 3D scalar wave integral equation Derivation and BEM approach

    Science.gov (United States)

    Lee, HyunSuk

    The Boundary Element Method (BEM) is a numerical method to solve partial differential equations (PDEs), which is derived from the integral equation (IE) that can be developed from certain PDEs. Among IEs, the 3D transient wave integral equation has a very special property which makes it distinguished from other integral equations; Dirac-delta and its derivative delta‧ appear in the fundamental-solution (or kernel-function). These delta and delta‧ generalized functions have continuity C-2 and C-3, respectively, and become a major hurdle for BEM implementation, because many numerical methods including BEM are based on the idea of continuity. More specifically, the integrands (kernel - shape function products) in the 3D transient wave IE become discontinuous (C-2 and C-3) and make numerical integration difficult. There are several existing approaches to overcome the delta difficulty, but none use the character of the Dirac-delta to cancel the integral. In this dissertation, a new method called the "Reduced order wave integral equation (Reduced IE)" is developed to deal with the difficulty in the 3D transient wave problem. In this approach, the sifting properties of delta and delta‧ are used to cancel an integration. As a result, smooth integrands are derived and the integral orders are reduced by one. Smooth integrands result in the more efficient and accurate numerical integration. In addition, there is no more coupling between the space-element size and time-step size. Non-zero initial condition (IC) can be considered also. Furthermore, space integrals need to be performed once, not per time-step. All of this reduces dramatically the computational requirement. As a result, the computation order for both time and space are reduced by 1 and one obtains an O(M N2) method, where M is the number of time steps and N is the number of spatial nodes on the boundary of the problem domain. A numerical approach to deal with the reduced IE is also suggested, and a simple

  5. An integrated approach for integrated intelligent instrumentation and control system (I3CS)

    International Nuclear Information System (INIS)

    Jung, C.H.; Kim, J.T.; Kwon, K.C.

    1997-01-01

    Nuclear power plants to guarantee the safety of public should be designed to reduce the operator intervention resulting in operating human errors, identify the process states in transients, and aid to make a decision of their tasks and guide operator actions. For the sake of this purpose, MMIS(MAN-Machine Interface System) in NPPs should be the integrated top-down approach tightly focused on the function-based task analysis including an advanced digital technology, an operator support function, and so on. The advanced I and C research team in KAERI has embarked on developing an Integrated Intelligent Instrumentation and Control System (I 3 CS) for Korea's next generation nuclear power plants. I 3 CS bases the integrated top-down approach on the function-based task analysis, modern digital technology, standardization and simplification, availability and reliability, and protection of investment. (author). 4 refs, 6 figs

  6. An approach to assessing stochastic radiogenic risk in medical imaging

    Energy Technology Data Exchange (ETDEWEB)

    Wolbarst, Anthony B.; Hendee, William R. [Department of Radiology, College of Medicine and Division of Radiation Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky 40536 (United States); Department of Radiology, Mayo Clinic, Rochester, Minnesota 55901 (United States)

    2011-12-15

    Purpose: This letter suggests a formalism, the medical effective dose (MED), that is suitable for assessing stochastic radiogenic risks in diagnostic medical procedures. Methods: The MED is derived from radiobiological and probabilistic first principals, including: (1) The independence of radiation-induced biological effects in neighboring voxels at low doses; (2) the linear no-threshold assumption for stochastic radiation injury (although other dose-response relationships could be incorporated, instead); (3) the best human radiation dose-response data currently available; and (4) the built-in possibility that the carcinogenic risk to an irradiated organ may depend on its volume. The MED involves a dose-risk summation over irradiated voxels at high spatial resolution; it reduces to the traditional effective dose when every organ is irradiated uniformly and when the dependence of risk on organ volumes is ignored. Standard relative-risk tissue weighting factors can be used with the MED approach until more refined data become available. Results: The MED is intended for clinical and phantom dosimetry, and it provides an estimate of overall relative radiogenic stochastic risk for any given dose distribution. A result of the MED derivation is that the stochastic risk may increase with the volume of tissue (i.e., the number of cells) irradiated, a feature that can be activated when forthcoming radiobiological research warrants it. In this regard, the MED resembles neither the standard effective dose (E) nor the CT dose index (CTDI), but it is somewhat like the CT dose-length product (DLP). Conclusions: The MED is a novel, probabilistically and biologically based means of estimating stochastic-risk-weighted doses associated with medical imaging. Built in, ab initio, is the ability to link radiogenic risk to organ volume and other clinical factors. It is straightforward to implement when medical dose distributions are available, provided that one is content, for the time

  7. Integrated reporting: A new approach to corporate reporting and management

    Directory of Open Access Journals (Sweden)

    Prošić Danica

    2015-01-01

    Full Text Available Integrated reporting is an opportunity to present a comprehensive picture of one's business in a clear, concise, coherent and comparable way. The idea of an integrated reporting and integration with non-financial data in the annual reports has many advantages and benefits compared to the current model of corporate reporting. Such approach enables us to consider the material issues facing our business and the community, and show how we create value for shareholders and society as a whole. At the same time, it also poses many new challenges, dilemmas and issues, at both accounting and managerial level. Among the key issues are those related to standards of reporting on non-financial aspects of business, methods of integrating financial and non- financial data and encouraging management to opt for modern and balanced reporting concept oriented towards the future, when the model is still being improved. Integrated reporting will be on the agenda of those companies in which top managers have recognized and understood the tangible benefits and sophistication of corporate reporting.

  8. The iterative adaptive approach in medical ultrasound imaging.

    Science.gov (United States)

    Jensen, Are Charles; Austeng, Andreas

    2014-10-01

    Many medical ultrasound imaging systems are based on sweeping the image plane with a set of narrow beams. Usually, the returning echo from each of these beams is used to form one or a few azimuthal image samples. We model, for each radial distance, jointly the full azimuthal scanline. The model consists of the amplitudes of a set of densely placed potential reflectors (or scatterers), cf. sparse signal representation. To fit the model, we apply the iterative adaptive approach (IAA) on data formed by a sequenced time delay and phase shift. The performance of the IAA in combination with our time-delayed and phase-shifted data are studied on both simulated data of scenes consisting of point targets and hollow cyst-like structures, and recorded ultrasound phantom data from a specially adapted commercially available scanner. The results show that the proposed IAA is more capable of resolving point targets and gives better defined and more geometrically correct cyst-like structures in speckle images compared with the conventional delay-and-sum (DAS) approach. Compared with a Capon beamformer, the IAA showed an improved rendering of cyst-like structures and a similar point-target resolvability. Unlike the Capon beamformer, the IAA has no user parameters and seems unaffected by signal cancellation. The disadvantage of the IAA is a high computational load.

  9. The Integrated Medical Model: A Decision Support Tool for In-flight Crew Health Care

    Science.gov (United States)

    Butler, Doug

    2009-01-01

    This viewgraph presentation reviews the development of an Integrated Medical Model (IMM) decision support tool for in-flight crew health care safety. Clinical methods, resources, and case scenarios are also addressed.

  10. The Development of Dialectical Thinking As An Approach to Integration

    Directory of Open Access Journals (Sweden)

    Michael Basseches

    2005-06-01

    Full Text Available This article offers a description of dialectical thinking as a psychological phenomenon that reflects adult intellectual development. While relating this psychological phenomenon to the various dialectical philosophical perspectives from which the description is derived, the article conceptualizes dialectical thinking as a form of organization of thought, various aspects of which can be identified in individual adults' approaches to conceptualizing a range of problems, rather than as one particular stream of intellectual history. The article provides a range of examples of dialectical analyses, contrasting them with more formalistic analyses, in order to convey the power, adequacy, and significance of dialectical thinking for the sorts of challenges that this journal embraces. It suggests that events in all areas of life demand recognition of the limitations of closed-system approaches to analysis. Approaches based instead on the organizing principle of dialectic integrate dimensions of contradiction, change and system-transformation over time in a way that supports people's adaptation when structures under girding their sense of self/world coherence are challenged. Higher education and psychotherapy are considered as examples of potential contexts for adult intellectual development, and the conditions that foster such development in these contexts are discussed. The article as a whole makes the case for consciously attempting to foster such development in all our work as an approach to integration.

  11. The Development of Dialectical Thinking As An Approach to Integration

    Directory of Open Access Journals (Sweden)

    Michael Basseches

    2005-06-01

    Full Text Available This article offers a description of dialectical thinking as a psychological phenomenon that reflects adult intellectual development. While relating this psychological phenomenon to the various dialectical philosophical perspectives from which the description is derived, the article conceptualizes dialectical thinking as a form of organization of thought, various aspects of which can be identified in individual adults’ approaches to conceptualizing a range of problems, rather than as one particular stream of intellectual history. The article provides a range of examples of dialectical analyses, contrasting them with more formalistic analyses, in order to convey the power, adequacy, and significance of dialectical thinking for the sorts of challenges that this journal embraces. It suggests that events in all areas of life demand recognition of the limitations of closed-system approaches to analysis. Approaches based instead on the organizing principle of dialectic integrate dimensions of contradiction, change and system-transformation over time in a way that supports people’s adaptation when structures under girding their sense of self/world coherence are challenged. Higher education and psychotherapy are considered as examples of potential contexts for adult intellectual development, and the conditions that foster such development in these contexts are discussed. The article as a whole makes the case for consciously attempting to foster such development in all our work as an approach to integration.

  12. Integration of Cognitive Skills as a Cross-Cutting Theme Into the Undergraduate Medical Curriculum at Tehran University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Akbar Soltani

    2017-02-01

    Full Text Available Nowadays, improvement of thinking skills of students is one of the universally supported aims in the majority of medical schools. This study aims to design longitudinal theme of reasoning, problem-solving and decision-making into the undergraduate medical curriculum at Tehran University of Medical Sciences (TUMS. A participatory approach was applied to design the curriculum during 2009-2011. The project was conducted by the contribution of representatives of both basic and clinical faculty members, students and graduates at Tehran University of Medical Sciences. The first step toward integrating cognitive skills into the curriculum was to assemble a taskforce of different faculty and students, including a wide variety of fields with multidisciplinary expertise using nonprobability sampling and the snowball method. Several meetings with the contribution of experts and some medical students were held to generate the draft of expected outcomes. Subsequently, the taskforce also determined what content would fit best into each phase of the program and what teaching and assessment methods would be more appropriate for each outcome. After a pilot curriculum with a small group of second-year medical students, we implemented this program for all first-year students since 2011 at TUMS. Based on findings, the teaching of four areas, including scientific and critical thinking skills (Basic sciences, problem-solving and reasoning (Pathophysiology, evidence-based medicine (Clerkship, and clinical decision-making (Internship were considered in the form of a longitudinal theme. The results of this study could be utilized as a useful pattern for integration of psycho-social subjects into the medical curriculum.

  13. Complex Product Architecture Analysis using an Integrated Approach

    Science.gov (United States)

    Uddin, Amad; Felician Campean, Ioan; Khurshid Khan, Mohammed

    2014-07-01

    Product design decomposition and synthesis is a constant challenge with its continuously increasing complexity at each level of abstraction. Currently, design decomposition and synthesis analytical tasks are mostly accomplished via functional and structural methods. These methods are useful in different phases of design process for product definition and architecture but limited in a way that they tend to focus more on 'what' and less on 'how' and vice versa. This paper combines a functional representation tool known as System State Flow Diagram (a solution independent approach), a solution search tool referred as Morphology Table, and Design Structure Matrix (mainly a solution dependent tool). The proposed approach incorporates Multiple Domain Matrix (MDM) to integrate the knowledge of both solution independent and dependent analyses. The approach is illustrated with a case study of solar robot toy, followed by its limitations, future work and discussion.

  14. Medication therapy disease management: Geisinger's approach to population health management.

    Science.gov (United States)

    Jones, Laney K; Greskovic, Gerard; Grassi, Dante M; Graham, Jove; Sun, Haiyan; Gionfriddo, Michael R; Murray, Michael F; Manickam, Kandamurugu; Nathanson, Douglas C; Wright, Eric A; Evans, Michael A

    2017-09-15

    Pharmacists' involvement in a population health initiative focused on chronic disease management is described. Geisinger Health System has cultivated a culture of innovation in population health management, as highlighted by its ambulatory care pharmacy program, the Medication Therapy Disease Management (MTDM) program. Initiated in 1996, the MTDM program leverages pharmacists' pharmacotherapy expertise to optimize care and improve outcomes. MTDM program pharmacists are trained and credentialed to manage over 16 conditions, including atrial fibrillation (AF) and multiple sclerosis (MS). Over a 15-year period, Geisinger Health Plan (GHP)-insured patients with AF whose warfarin therapy was managed by the MTDM program had, on average, 18% fewer emergency department (ED) visits and 18% fewer hospitalizations per year than GHP enrollees with AF who did not receive MTDM services, with 23% lower annual total care costs. Over a 2-year period, GHP-insured patients with MS whose pharmacotherapy was managed by pharmacists averaged 28% fewer annual ED visits than non-pharmacist-managed patients; however, the mean annual total care cost was 21% higher among MTDM clinic patients. The Geisinger MTDM program has evolved over 20 years from a single pharmacist-run anticoagulation clinic into a large program focused on managing the health of an ever-growing population. Initial challenges in integrating pharmacists into the Geisinger patient care framework as clinical experts were overcome by demonstrating the MTDM program's positive impact on patient outcomes. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  15. Auditory-Verbal Music Play Therapy: An Integrated Approach (AVMPT).

    Science.gov (United States)

    Mohammad Esmaeilzadeh, Sahar; Sharifi, Shahla; Tayarani Niknezhad, Hamid

    2013-09-01

    Hearing loss occurs when there is a problem with one or more parts of the ear or ears and causes children to have a delay in the language-learning process. Hearing loss affects children's lives and their development. Several approaches have been developed over recent decades to help hearing-impaired children develop language skills. Auditory-verbal therapy (AVT) is one such approach. Recently, researchers have found that music and play have a considerable effect on the communication skills of children, leading to the development of music therapy (MT) and play therapy (PT). There have been several studies which focus on the impact of music on hearing-impaired children. The aim of this article is to review studies conducted in AVT, MT, and PT and their efficacy in hearing-impaired children. Furthermore, the authors aim to introduce an integrated approach of AVT, MT, and PT which facilitates language and communication skills in hearing-impaired children. In this article we review studies of AVT, MT, and PT and their impact on hearing-impaired children. To achieve this goal, we searched databases and journals including Elsevier, Chor Teach, and Military Psychology, for example. We also used reliable websites such as American Choral Directors Association and Joint Committee on Infant Hearing websites. The websites were reviewed and key words in this article used to find appropriate references. Those articles which are related to ours in content were selected. VT, MT, and PT enhance children's communication and language skills from an early age. Each method has a meaningful impact on hearing loss, so by integrating them we have a comprehensive method in order to facilitate communication and language learning. To achieve this goal, the article offers methods and techniques to perform AVT and MT integrated with PT leading to an approach which offers all advantages of these three types of therapy.

  16. Integrating cell biology and proteomic approaches in plants.

    Science.gov (United States)

    Takáč, Tomáš; Šamajová, Olga; Šamaj, Jozef

    2017-10-03

    Significant improvements of protein extraction, separation, mass spectrometry and bioinformatics nurtured advancements of proteomics during the past years. The usefulness of proteomics in the investigation of biological problems can be enhanced by integration with other experimental methods from cell biology, genetics, biochemistry, pharmacology, molecular biology and other omics approaches including transcriptomics and metabolomics. This review aims to summarize current trends integrating cell biology and proteomics in plant science. Cell biology approaches are most frequently used in proteomic studies investigating subcellular and developmental proteomes, however, they were also employed in proteomic studies exploring abiotic and biotic stress responses, vesicular transport, cytoskeleton and protein posttranslational modifications. They are used either for detailed cellular or ultrastructural characterization of the object subjected to proteomic study, validation of proteomic results or to expand proteomic data. In this respect, a broad spectrum of methods is employed to support proteomic studies including ultrastructural electron microscopy studies, histochemical staining, immunochemical localization, in vivo imaging of fluorescently tagged proteins and visualization of protein-protein interactions. Thus, cell biological observations on fixed or living cell compartments, cells, tissues and organs are feasible, and in some cases fundamental for the validation and complementation of proteomic data. Validation of proteomic data by independent experimental methods requires development of new complementary approaches. Benefits of cell biology methods and techniques are not sufficiently highlighted in current proteomic studies. This encouraged us to review most popular cell biology methods used in proteomic studies and to evaluate their relevance and potential for proteomic data validation and enrichment of purely proteomic analyses. We also provide examples of

  17. RISK MANAGEMENT: AN INTEGRATED APPROACH TO RISK MANAGEMENT AND ASSESSMENT

    Directory of Open Access Journals (Sweden)

    Szabo Alina

    2012-12-01

    Full Text Available Purpose: The objective of this paper is to offer an overview over risk management cycle by focusing on prioritization and treatment, in order to ensure an integrated approach to risk management and assessment, and establish the ‘top 8-12’ risks report within the organization. The interface with Internal Audit is ensured by the implementation of the scoring method to prioritize risks collected from previous generated risk report. Methodology/approach: Using evidence from other research in the area and the professional expertise, this article outlines an integrated approach to risk assessment and risk management reporting processes, by separating the risk in two main categories: strategic and operational risks. The focus is on risk prioritization and scoring; the final output will comprise a mix of strategic and operational (‘top 8-12’ risks, which should be used to establish the annual Internal Audit plan. Originality/value: By using an integrated approach to risk assessment and risk management will eliminate the need for a separate Internal Audit risk assessment over prevailing risks. It will reduce the level of risk assessment overlap by different functions (Tax, Treasury, Information System over the same risk categories as a single methodology, is used and will align timings of risk assessment exercises. The risk prioritization by usage of risk and control scoring criteria highlights the combination between financial and non-financial impact criteria allowing risks that do not naturally lend themselves to a financial amount to be also assessed consistently. It is emphasized the usage of score method to prioritize the risks included in the annual audit plan in order to increase accuracy and timelines.

  18. Bayesian Analysis for Risk Assessment of Selected Medical Events in Support of the Integrated Medical Model Effort

    Science.gov (United States)

    Gilkey, Kelly M.; Myers, Jerry G.; McRae, Michael P.; Griffin, Elise A.; Kallrui, Aditya S.

    2012-01-01

    The Exploration Medical Capability project is creating a catalog of risk assessments using the Integrated Medical Model (IMM). The IMM is a software-based system intended to assist mission planners in preparing for spaceflight missions by helping them to make informed decisions about medical preparations and supplies needed for combating and treating various medical events using Probabilistic Risk Assessment. The objective is to use statistical analyses to inform the IMM decision tool with estimated probabilities of medical events occurring during an exploration mission. Because data regarding astronaut health are limited, Bayesian statistical analysis is used. Bayesian inference combines prior knowledge, such as data from the general U.S. population, the U.S. Submarine Force, or the analog astronaut population located at the NASA Johnson Space Center, with observed data for the medical condition of interest. The posterior results reflect the best evidence for specific medical events occurring in flight. Bayes theorem provides a formal mechanism for combining available observed data with data from similar studies to support the quantification process. The IMM team performed Bayesian updates on the following medical events: angina, appendicitis, atrial fibrillation, atrial flutter, dental abscess, dental caries, dental periodontal disease, gallstone disease, herpes zoster, renal stones, seizure, and stroke.

  19. Medical Affairs Efficiency in Pharma – a Pragmatic Approach to Success

    Directory of Open Access Journals (Sweden)

    José Aleixo Dias

    2014-10-01

    Full Text Available Along recent years Pharma operations became increasingly complex. Trying to adapt to the requests of a fast changing and demanding environment, companies moved from the standard medical, marketing and sales structure to a much more complex puzzle of units, departments, internal and external reporting lines. Along with these, the number of functions increased so much that titles became confused for customers as for colleagues. The number of systems and tools grew alike; some are useful while others not compatible or redundant. The medical structure which was minimal two decades ago, increased to meet the requirements for scientific evidence, both from prescribers and payers. The roles of these medical affairs (MA functions, the way these are organized, the processes of interaction with other relevant players, their contribution to capture insights and translate these into actions, their reporting lines and the impact generated for the business and to the customers, are very much under discussion. Companies have been adopting different models to respond to these needs, but the change is constant, showing that most probably, the best fit has not yet been reached. The customer facing medical is a natural strategic evolution of the traditional MA role, demonstrating value, business alignment, integration and governance, which are essential pillars in building customer partnerships. This article describes the situation, and discusses pragmatic approaches to some of the most common challenges and issues, aiming to contribute to the improvement and effectiveness of the MA operations.

  20. An approach to developing an integrated pyro processing simulator

    International Nuclear Information System (INIS)

    Lee, H.J.; Ko, I.W.; Choi, S.Y.; Kim, S.K.; Kim, I.T.; Lee, H.S.

    2013-01-01

    Full-text:Pyro processing has been studied for a decade as one of the promising fuel recycling options in Korea. We have built a pyro processing integrated inactive demonstration facility (PRIDE) to assess the feasibility of integrated pyro processing technology and scale-up issues of the processing equipment. Even though such facility cannot be replaced with a real integrated facility using spent nuclear fuel (SF), many insights can be obtained in terms of the worlds largest integrated pyro processing operation. In order to complement or overcome such limited test-based research, a pyro processing Modelling and simulation study began in 2011. The Korea Atomic Energy Research Institute (KAERI) suggested a Modelling architecture for the development of a multi-purpose pyro processing simulator consisting of three-tiered models: unit process, operation, and plant-level-model. The unit process model can be addressed using governing equations or empirical equations as a continuous system (CS). In contrast, the operation model describes the operational behaviors as a discrete event system (DES). The plant-level model is an integrated model of the unit process and an operation model with various analysis modules. An interface with different systems, the incorporation of different codes, a process-centered database design, and a dynamic material flow are discussed as necessary components for building a framework of the plant-level model. As a sample model that contains methods decoding the above engineering issues was thoroughly reviewed, the architecture for building the plant-level-model was verified. By analyzing a process and operation-combined model, we showed that the suggested approach is effective for comprehensively understanding an integrated dynamic material flow. This paper addressed the current status of the pyro processing Modelling and simulation activity at KAERI, and also predicted its path forward. (author)

  1. A path integral approach to the Hodgkin-Huxley model

    Science.gov (United States)

    Baravalle, Roman; Rosso, Osvaldo A.; Montani, Fernando

    2017-11-01

    To understand how single neurons process sensory information, it is necessary to develop suitable stochastic models to describe the response variability of the recorded spike trains. Spikes in a given neuron are produced by the synergistic action of sodium and potassium of the voltage-dependent channels that open or close the gates. Hodgkin and Huxley (HH) equations describe the ionic mechanisms underlying the initiation and propagation of action potentials, through a set of nonlinear ordinary differential equations that approximate the electrical characteristics of the excitable cell. Path integral provides an adequate approach to compute quantities such as transition probabilities, and any stochastic system can be expressed in terms of this methodology. We use the technique of path integrals to determine the analytical solution driven by a non-Gaussian colored noise when considering the HH equations as a stochastic system. The different neuronal dynamics are investigated by estimating the path integral solutions driven by a non-Gaussian colored noise q. More specifically we take into account the correlational structures of the complex neuronal signals not just by estimating the transition probability associated to the Gaussian approach of the stochastic HH equations, but instead considering much more subtle processes accounting for the non-Gaussian noise that could be induced by the surrounding neural network and by feedforward correlations. This allows us to investigate the underlying dynamics of the neural system when different scenarios of noise correlations are considered.

  2. Optimal Integration of Intermittent Renewables: A System LCOE Stochastic Approach

    Directory of Open Access Journals (Sweden)

    Carlo Lucheroni

    2018-03-01

    Full Text Available We propose a system level approach to value the impact on costs of the integration of intermittent renewable generation in a power system, based on expected breakeven cost and breakeven cost risk. To do this, we carefully reconsider the definition of Levelized Cost of Electricity (LCOE when extended to non-dispatchable generation, by examining extra costs and gains originated by the costly management of random power injections. We are thus lead to define a ‘system LCOE’ as a system dependent LCOE that takes properly into account intermittent generation. In order to include breakeven cost risk we further extend this deterministic approach to a stochastic setting, by introducing a ‘stochastic system LCOE’. This extension allows us to discuss the optimal integration of intermittent renewables from a broad, system level point of view. This paper thus aims to provide power producers and policy makers with a new methodological scheme, still based on the LCOE but which updates this valuation technique to current energy system configurations characterized by a large share of non-dispatchable production. Quantifying and optimizing the impact of intermittent renewables integration on power system costs, risk and CO 2 emissions, the proposed methodology can be used as powerful tool of analysis for assessing environmental and energy policies.

  3. A Integracao de Ensino das Ciencias da Saude (An Integrated Medical Education Program [in Brazil]).

    Science.gov (United States)

    Pourchet-Campos, M. A.; Guimaraes Junior, Paulino

    At the Sixth Annual Reunion of the Brazilian Association of Medical Schools (VI Reuniao Anual da Associacao Brasileira de Escolas Medicas) leaders in the Brazilian medical profession proposed an integrated educational program for training students in the fields of medicine and public health. Under Brazil's present system of education, all…

  4. Positive Impact of Integrating Histology and Physiology Teaching at a Medical School in China

    Science.gov (United States)

    Sherer, Renslow; Wan, Yu; Dong, Hongmei; Cooper, Brian; Morgan, Ivy; Peng, Biwen; Liu, Jun; Wang, Lin; Xu, David

    2014-01-01

    To modernize its stagnant, traditional curriculum and pedagogy, the Medical School of Wuhan University in China adopted (with modifications) the University of Chicago's medical curriculum model. The reform effort in basic sciences was integrating histology and physiology into one course, increasing the two subjects' connection to clinical…

  5. Integrating the teaching role into one's identity : a qualitative study of beginning undergraduate medical teachers

    NARCIS (Netherlands)

    Van, Lankveld T.; Schoonenboom, J.; Kusurkar, R.A.; Volman, M.; Beishuizen, J.; Croiset, G.

    2017-01-01

    Beginning medical teachers often see themselves as doctors or researchers rather than as teachers. Using both figured worlds theory and dialogical self theory, this study explores how beginning teachers in the field of undergraduate medical education integrate the teacher role into their identity. A

  6. [Application of supply chain integration management of medical consumables].

    Science.gov (United States)

    Zhang, Jian

    2013-07-01

    This paper introduces the background, the content, the information management system of material supply chain integration management and the consumables management process. The system helps to expand the selection of hospital supplies varieties, to reduce consumables management costs, to improve the efficiency of supplies, to ensure supplies safety, reliability and traceability.

  7. Integrated Nationwide Electronic Health Records system: Semi-distributed architecture approach.

    Science.gov (United States)

    Fragidis, Leonidas L; Chatzoglou, Prodromos D; Aggelidis, Vassilios P

    2016-11-14

    The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving. This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture. The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data synchronization architecture for the proposed solution. The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data. The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost.

  8. Self-Referent Constructs and Medical Sociology: In Search of an Integrative Framework*

    Science.gov (United States)

    Kaplan, Howard B.

    2010-01-01

    A theoretical framework centering on four classes of self-referent constructs is offered as a device for integrating the diverse areas constituting medical sociology. Guidance by this framework sensitizes the researcher to the occurrence of parallel processes in adjacent disciplines, facilitates recognition of the etiological significance of findings from other disciplines for explaining medical sociological phenomena, and encourages transactions between sociology and medical sociology whereby each informs and is informed by the other. PMID:17583268

  9. Studying integrated health care systems with a structurationist approach

    Science.gov (United States)

    Demers, Louis; Arseneault, Stéphane; Couturier, Yves

    2010-01-01

    Introduction To implement an integrated health care system is not an easy task and to ensure its sustainability is yet more difficult. Aim Discuss how a structurationist approach can shed light on the stakes of these processes and guide the managers of such endeavours. Theory and method Structuration theory [1] has been used by numerous authors to cast new light on complex organizational phenomena. One of the central tenets of this theory is that social systems, such as integrated health care systems, are recurrent social practices across time-space and are characterized by structural properties which simultaneously constrain and enable the constitutive social actors who reproduce and transform the system through their practices. We will illustrate our theoretical standpoint with empirical material gathered during the study of an integrated health care system for the frail elderly in Quebec, Canada. This system has been implemented in 1997 and is still working well in 2010. Results and conclusion To implement an integrated health care system that is both effective and sustainable, its managers must shrewdly allow for the existing system and progressively introduce changes in the way managers and practitioners at work in the system view their role and act on a daily basis.

  10. An Overview of Integrated Logistic Support in Medical Material Programs.

    Science.gov (United States)

    1980-12-01

    v sor Chairman,, De e of" inistrative Sciences Dean of information and Policy § ciences 3 ........... ABSTRACT This thesis addresses the...and equipment control. 4. There is a need for increased ILS education for Medical Service Corps officers. Key officers should be identified who are...Economics, p. 60, Lexington Books, D. C. Heath and Company, 1977. 37. Ibid., pp. 78-79. 38. Naval Education and Training Command, Financial Manage- ment in

  11. How Iranian Medical Trainees Approach their Responsibilities in Clinical Settings; A Grounded Theory Research

    Directory of Open Access Journals (Sweden)

    Omid Asemani

    2015-09-01

    Full Text Available Background: It seems we are now experiencing “responsibility problems” among medical trainees (MTs and some of those recently graduated from medical schools in Iran. Training responsible professionals have always been one of the main concerns of medical educators. Nevertheless, there is a dearth of research in the literature on “responsibility” especially from the medical education point of view. Therefore, the present study was carried out with the aim of presenting a theoretical based framework for understanding how MTs approach their responsibilities in educational settings. Method: This qualitative study was conducted at Shiraz University of Medical Sciences (SUMS using the grounded theory methodology. 15 MTs and 10 clinical experts and professional nurses were purposefully chosen as participants. Data was analyzed using the methodology suggested by Corbin and Strauss, 1998. Results: “Try to find acceptance toward expectations”, “try to be committed to meet the expectations” and “try to cope with unacceptable expectations” were three main categories extracted based on the research data. Abstractly, the main objective for using these processes was “to preserve the integrity of student identity” which was the core category of this research too. Moreover, it was also found that practically, “responsibility” is considerably influenced by lots of positive and negative contextual and intervening conditions. Conclusion: “Acceptance” was the most decisive variable highly effective in MTs’ responsibility. Therefore, investigating the “process of acceptance” regarding the involved contextual and intervening conditions might help medical educators correctly identify and effectively control negative factors and reinforce the constructive ones that affect the concept of responsibility in MTs.

  12. Sustainable solid waste management: An integrated approach for Asian countries

    International Nuclear Information System (INIS)

    Shekdar, Ashok V.

    2009-01-01

    Solid waste management (SWM) has been an integral part of every human society. The approaches for SWM should be compatible with the nature of a given society, and, in this regard, Asian countries are no exception. In keeping with global trends, the systems are being oriented to concentrate on sustainability issues; mainly through the incorporation of 3R (reduce, reuse and recycle) technologies. However, degree and nature of improvements toward sustainability are varying and depend on the economic status of a country. High-income countries like Japan and South Korea can afford to spend more to incorporate 3R technologies. Most of the latest efforts focus on 'Zero Waste' and/or 'Zero Landfilling' which is certainly expensive for weaker economies such as those of India or Indonesia. There is a need to pragmatically assess the expectations of SWM systems in Asian countries. Hence, in this paper, we analyze the situation in different Asian countries, and explore future trends. We conceptually evaluate issues surrounding the sustainability of SWM. We propose a multi-pronged integrated approach for improvement that achieves sustainable SWM in the context of national policy and legal frameworks, institutional arrangement, appropriate technology, operational and financial management, and public awareness and participation. In keeping with this approach, a generic action plan has been proposed that could be tailored to suit a situation in a particular country. Our proposed concept and action plan framework would be useful across a variety of country-specific scenarios

  13. Sustainable solid waste management: an integrated approach for Asian countries.

    Science.gov (United States)

    Shekdar, Ashok V

    2009-04-01

    Solid waste management (SWM) has been an integral part of every human society. The approaches for SWM should be compatible with the nature of a given society, and, in this regard, Asian countries are no exception. In keeping with global trends, the systems are being oriented to concentrate on sustainability issues; mainly through the incorporation of 3R (reduce, reuse and recycle) technologies. However, degree and nature of improvements toward sustainability are varying and depend on the economic status of a country. High-income countries like Japan and South Korea can afford to spend more to incorporate 3R technologies. Most of the latest efforts focus on "Zero Waste" and/or "Zero Landfilling" which is certainly expensive for weaker economies such as those of India or Indonesia. There is a need to pragmatically assess the expectations of SWM systems in Asian countries. Hence, in this paper, we analyze the situation in different Asian countries, and explore future trends. We conceptually evaluate issues surrounding the sustainability of SWM. We propose a multi-pronged integrated approach for improvement that achieves sustainable SWM in the context of national policy and legal frameworks, institutional arrangement, appropriate technology, operational and financial management, and public awareness and participation. In keeping with this approach, a generic action plan has been proposed that could be tailored to suit a situation in a particular country. Our proposed concept and action plan framework would be useful across a variety of country-specific scenarios.

  14. Extending the theoretical framework for curriculum integration in pre-clinical medical education

    DEFF Research Database (Denmark)

    Vergel, John; Stentoft, Diana; Montoya, Juny

    2017-01-01

    INTRODUCTION: Curriculum integration is widely discussed in medical education but remains ill defined. Although there is plenty of information on logistical aspects of curriculum integration, little attention has been paid to the contextual issues that emerge from its practice and may complicate ...

  15. Evaluation of Chest Ultrasound Integrated Teaching of Respiratory System Physiology to Medical Students

    Science.gov (United States)

    Paganini, Matteo; Bondì, Michela; Rubini, Alessandro

    2017-01-01

    Ultrasound imaging is a widely used diagnostic technique, whose integration in medical education is constantly growing. The aim of this study was to evaluate chest ultrasound usefulness in teaching respiratory system physiology, students' perception of chest ultrasound integration into a traditional lecture in human physiology, and short-term…

  16. Integrated Microreactors for Reaction Automation: New Approaches to Reaction Development

    Science.gov (United States)

    McMullen, Jonathan P.; Jensen, Klavs F.

    2010-07-01

    Applications of microsystems (microreactors) in continuous-flow chemistry have expanded rapidly over the past two decades, with numerous reports of higher conversions and yields compared to conventional batch benchtop equipment. Synthesis applications are enhanced by chemical information gained from integrating microreactor components with sensors, actuators, and automated fluid handling. Moreover, miniaturized systems allow experiments on well-defined samples at conditions not easily accessed by conventional means, such as reactions at high pressure and temperatures. The wealth of synthesis information that could potentially be acquired through use of microreactors integrated with physical sensors and analytical chemistry techniques for online reaction monitoring has not yet been well explored. The increased efficiency resulting from use of continuous-flow microreactor platforms to automate reaction screening and optimization encourages a shift from current batchwise chemical reaction development to this new approach. We review advances in this new area and provide application examples of online monitoring and automation.

  17. CSR Integration into the Financial Economy: A Conceptual Approach

    Directory of Open Access Journals (Sweden)

    Georgiana - Loredana FRECEA

    2016-06-01

    Full Text Available Corporate social responsibility is a complex concept and its design integrates economic, social and environmental issues, pointing out the operational effects on a voluntary basis. It is considered a strategic point in the actual evolution of the economy, due to the financial market dynamism, being identified a critical correlation between financial crises and corporate social responsibility. The main purpose of this paper is to synthesize, through a literature review, the multiple dimensions of CSR, with a special emphasis on the theoretical approach. In order to provide a coherent overview on the banking CSR, it will be proposed a division of the CSR theories according to: (1 the ethical approach, (2 the stakeholders approach, and (3 the corporate governance approach. The major aim of this paper is to fill a gap in the theoretical approach of the CSR for the banking system, due to the necessity to unify the CSR reporting elements in order to find a balance between the bank’s organizational structure and their legitimacy to operate on the financial market.

  18. Approaches and Study Skills of Veterinary Medical Students: Effects of a Curricular Revision.

    Science.gov (United States)

    Zamor, Eliza; Chigerwe, Munashe; Boudreaux, Karen A; Ilkiw, Jan E

    The objective of this study was to determine if a revised, recently implemented curriculum, embracing an integrated block design with a focus on student-centered, inquiry-based learning, had a different effect on veterinary medical students' approaches to studying than the previous curriculum. A total of 577 students completed a questionnaire consisting of the short version of the Approaches and Study Skills Inventory for Students (ASSIST). It included questions relating to conceptions about learning, approaches to studying, and preferences for different types of courses and teaching. In addition, students were asked to respond to general questions regarding the design of the revised curriculum. The scores for the deep and strategic learning approaches were higher for students studying under the previous curriculum compared to the revised curriculum, despite the fact that the revised curriculum was specifically designed to foster deep learning. The scores for the surface learning approach were lower in the students studying the revised curriculum compared to students studying under the previous curriculum. We identified the following factors affecting student learning: alteration of learning activities, such as problem-based learning, from the recommended models; a lack of instructor support for the revised curriculum; assessments that were not aligned to encourage critical thinking; and directed self-learning activities that were too comprehensive to complete in the allotted time. The results of this study can be used to improve the implementation of student-centered and inquiry-based curricula by identifying potential problems that could prevent a deep learning approach in veterinary medical students.

  19. Integrating addiction medicine training into medical school and residency curricula

    OpenAIRE

    Klimas, Jan; Rieb, Launette; Bury, Gerard; Muench, John; O?Toole, Thomas; Rieckman, Traci; Cullen, Walter

    2015-01-01

    peer-reviewed Background: The Affordable Care Act (2010) brings an opportunity to increase the integration of addiction treatment into the health care system. With the anticipated expansion of addiction care services in primary care, challenges, such as workforce training, can be expected. This presentation discusses challenges and opportunities for addiction medicine training of primary care professionals in Ireland, Canada and Portland, OR. Objectives: To explore ideas for integratin...

  20. Semantic Integration of Cervical Cancer Data Repositories to Facilitate Multicenter Association Studies: The ASSIST Approach

    Directory of Open Access Journals (Sweden)

    Theodoros Agorastos

    2009-02-01

    Full Text Available The current work addresses the unification of Electronic Health Records related to cervical cancer into a single medical knowledge source, in the context of the EU-funded ASSIST research project. The project aims to facilitate the research for cervical precancer and cancer through a system that virtually unifies multiple patient record repositories, physically located in different medical centers/hospitals, thus, increasing flexibility by allowing the formation of study groups “on demand” and by recycling patient records in new studies. To this end, ASSIST uses semantic technologies to translate all medical entities (such as patient examination results, history, habits, genetic profile and represent them in a common form, encoded in the ASSIST Cervical Cancer Ontology. The current paper presents the knowledge elicitation approach followed, towards the definition and representation of the disease’s medical concepts and rules that constitute the basis for the ASSIST Cervical Cancer Ontology. The proposed approach constitutes a paradigm for semantic integration of heterogeneous clinical data that may be applicable to other biomedical application domains.

  1. Supporting teachers integrating web 2.0 in a Problem Based Learning approach

    DEFF Research Database (Denmark)

    Buus, Lillian

    2010-01-01

    Based on theoretical and methodological considerations within problem-based learning (PBL), web 2.0 technologies and learning designs, the article try to illustrate a design model for supporting teachers in their learning design trying to integrate web 2.0 technologies into their PBL approach...... at Aalborg University (AAU). Problem-Based Learning (PBL) has gained a lot of interest since it was launched in established educational settings over 30 years ago in the medical programmes at McMaster University, Canada. Essentially it is a leaning methods based on the principle of using problems...... that a transition from curriculum-based teaching to PBL entails a movement from a teacher-centered approach to a learner-centered approach [4],[5]. This move can in many ways be compared to the conceptual move from web 1.0 to web 2.0 that by some is seen as a transition from ‘users/learners as consumers’ towards...

  2. Medical Dataset Classification: A Machine Learning Paradigm Integrating Particle Swarm Optimization with Extreme Learning Machine Classifier.

    Science.gov (United States)

    Subbulakshmi, C V; Deepa, S N

    2015-01-01

    Medical data classification is a prime data mining problem being discussed about for a decade that has attracted several researchers around the world. Most classifiers are designed so as to learn from the data itself using a training process, because complete expert knowledge to determine classifier parameters is impracticable. This paper proposes a hybrid methodology based on machine learning paradigm. This paradigm integrates the successful exploration mechanism called self-regulated learning capability of the particle swarm optimization (PSO) algorithm with the extreme learning machine (ELM) classifier. As a recent off-line learning method, ELM is a single-hidden layer feedforward neural network (FFNN), proved to be an excellent classifier with large number of hidden layer neurons. In this research, PSO is used to determine the optimum set of parameters for the ELM, thus reducing the number of hidden layer neurons, and it further improves the network generalization performance. The proposed method is experimented on five benchmarked datasets of the UCI Machine Learning Repository for handling medical dataset classification. Simulation results show that the proposed approach is able to achieve good generalization performance, compared to the results of other classifiers.

  3. Medical Dataset Classification: A Machine Learning Paradigm Integrating Particle Swarm Optimization with Extreme Learning Machine Classifier

    Directory of Open Access Journals (Sweden)

    C. V. Subbulakshmi

    2015-01-01

    Full Text Available Medical data classification is a prime data mining problem being discussed about for a decade that has attracted several researchers around the world. Most classifiers are designed so as to learn from the data itself using a training process, because complete expert knowledge to determine classifier parameters is impracticable. This paper proposes a hybrid methodology based on machine learning paradigm. This paradigm integrates the successful exploration mechanism called self-regulated learning capability of the particle swarm optimization (PSO algorithm with the extreme learning machine (ELM classifier. As a recent off-line learning method, ELM is a single-hidden layer feedforward neural network (FFNN, proved to be an excellent classifier with large number of hidden layer neurons. In this research, PSO is used to determine the optimum set of parameters for the ELM, thus reducing the number of hidden layer neurons, and it further improves the network generalization performance. The proposed method is experimented on five benchmarked datasets of the UCI Machine Learning Repository for handling medical dataset classification. Simulation results show that the proposed approach is able to achieve good generalization performance, compared to the results of other classifiers.

  4. Integrated approach to yoga therapy and autism spectrum disorders

    Directory of Open Access Journals (Sweden)

    Shantha Radhakrishna

    2010-01-01

    Full Text Available A specially designed Integrated Approach to Yoga Therapy module was applied to Autism Spectrum Disorders over a period of two academic years. Despite low numbers (six in each arm, consistency and magnitude of effects make the findings significant. Parental participation, allowing firm guidance to be given to each child, resulted in significant improvements in imitation and other skills, and in behavior at home and family relationships. We hypothesize that guided imitation of therapist body positions stimulated mirror neuron activation, resulting in improved sense of self.

  5. The Need for Integrated Approaches in Metabolic Engineering

    Energy Technology Data Exchange (ETDEWEB)

    Lechner, Anna; Brunk, Elizabeth; Keasling, Jay D.

    2016-08-15

    This review highlights state-of-the-art procedures for heterologous small-molecule biosynthesis, the associated bottlenecks, and new strategies that have the potential to accelerate future accomplishments in metabolic engineering. We emphasize that a combination of different approaches over multiple time and size scales must b e considered for successful pathway engineering in a heterologous host. We have classified these optimization procedures based on the "system" that is being manipulated: transcriptome, translatome, proteome, or reactome. By bridging multiple disciplines, including molecular biology, biochemistry, biophysics, and computational sciences, we can create an integral framework for the discovery and implementation of novel biosynthetic production routes.

  6. The disposition of nuclear waste: an integrated international approach

    International Nuclear Information System (INIS)

    Waltar, A.E.

    2001-01-01

    This paper proposes the establishment of a new, globally integrated approach for dealing with spent nuclear fuel (SNF), high-level waste, and plutonium supplies. The end product is envisioned to be a new global agency (tentatively called the International Nuclear Waste Authority, or INWA), which would have the authority to establish and enforce all nuclear waste disposal standards and subsequently execute all financial arrangements appropriate for obtaining full-scale global implementation. We suggest the IAEA as the logical existing organization to facilitate generating the structure for the INWA. (author)

  7. Angina in a diabetic patient: a case of integrated approach

    Directory of Open Access Journals (Sweden)

    Eugenio Roberto Cosentino

    2008-09-01

    Full Text Available Diabetes mellitus, both of type 1 and 2, is an important risk factor for the development of atherosclerosis: in diabetic patients vascular atherosclerotic complications are responsible of approximately 80% of all the deaths. There is no doubt that patients affections originating from diabetes and coronaropathy remain at high risk. For this reason it is essential to adopt an aggressive strategy of secondary prevention. We report a case of a patient with multiple risk factors for cardiovascular diseases: the successful management was due to an integrated approach that involved the general practitioner and cardiologist.

  8. Design and development of an integral high-resolution radiation dosimetry system for medical applications

    International Nuclear Information System (INIS)

    Vedelago, J; Valente, M.

    2013-01-01

    Requirements for overall high performance of dosimetry systems increases due to the growing complexity of medical treatments. Non conventional treatment modalities like Boron Neutron Capture Treatment (BNCT) and hadron therapy, as well as conventional modern methods like IMRT, Tomotherapy might significantly improve diseases control. The Fricke gel dosimetry is a valuable method for in-phantom dose measurements in complex irradiation modalities like IMRT and BNCT. Implementation of this technique requires dedicated instruments capable of measuring and further analysis immediately in situ at the radiation facility. This work presents a novel and integral dosimetry system aimed to attain portability requirements. It is based on Fricke gel dosimeter optically analyzed offering several specific advantages like tissue-equivalence and continuos 3D dose mapping. Moreover, the versatilities of Fricke gel dosimetry about different chemical and isotopic compositions allows its application on different high performance conventional and non conventional radiation procedures. Specific radiation transport models were developed with the aim of enabling relative simple optical technique for sample analysis. Theoretical approaches are supported by analytical solution of Boltzmann s equation of radiation transport. Instrumentations design and construction were completely realized at the facilities of the Laboratorio de Investigaciones e Instrumentacion en Fisica Aplicada a la Medicina e Imagenes por Rayos X - LIIFAMIR ).The developed integral dosimetry system includes dedicated software for data acquisition and further processing in order to employ the system set up for direct in situ measurements for routine clinical scopes

  9. Contextualizing integration: a critical social science approach to integrative health care.

    Science.gov (United States)

    Adams, Jon; Hollenberg, Daniel; Lui, Chi-Wai; Broom, Alex

    2009-01-01

    This article argues for the importance of examining the phenomenon of integrative health care in broader social and historical contexts. The authors examine mainstream approaches to identify patterns of integrative medicine and criticize them for their neglect of clashes among different philosophical paradigms and the wider social contexts that govern health care in practice. The authors outline a framework and highlight the values of a critical social science perspective in deepening our understanding of recent transformations in health care practice and issues surrounding biomedicine and complementary/alternative medicine (including chiropractic, naturopathy, massage, acupuncture/oriental medicine, etc) and traditional medicine. A critical social science perspective pays special attention to complex power relations, inclusionary/exclusionary strategies, and interprofessional dynamics in medicine. Drawing upon recent research findings, the authors illustrate how such a perspective reveals the intricacies and tensions that surround the integration of different paradigms of health care practice. The authors summarize the importance of situating integrative health care in structural contexts and affirm their commitment to a critical social science approach.

  10. A design approach for integrating thermoelectric devices using topology optimization

    DEFF Research Database (Denmark)

    Soprani, Stefano; Haertel, Jan Hendrik Klaas; Lazarov, Boyan Stefanov

    2016-01-01

    to operate more efficiently. This work proposes and experimentally demonstrates a topology optimization approach as a design tool for efficient integration of thermoelectric modules into systems with specific design constraints. The approach allows thermal layout optimization of thermoelectric systems....... The design method incorporates temperature dependent properties of the thermoelectric device and other materials. The3D topology optimization model developed in this work was used to design a thermoelectric system, complete with insulation and heat sink, that was produced and tested. Good agreement between...... experimental results and model forecasts was obtained and the system was able to maintain the load at more than 33 K below the oil well temperature. Results of this study support topology optimizationas a powerful design tool for thermal design of thermoelectric systems....

  11. An integrated modeling approach to age invariant face recognition

    Science.gov (United States)

    Alvi, Fahad Bashir; Pears, Russel

    2015-03-01

    This Research study proposes a novel method for face recognition based on Anthropometric features that make use of an integrated approach comprising of a global and personalized models. The system is aimed to at situations where lighting, illumination, and pose variations cause problems in face recognition. A Personalized model covers the individual aging patterns while a Global model captures general aging patterns in the database. We introduced a de-aging factor that de-ages each individual in the database test and training sets. We used the k nearest neighbor approach for building a personalized model and global model. Regression analysis was applied to build the models. During the test phase, we resort to voting on different features. We used FG-Net database for checking the results of our technique and achieved 65 percent Rank 1 identification rate.

  12. Advanced multiresponse process optimisation an intelligent and integrated approach

    CERN Document Server

    Šibalija, Tatjana V

    2016-01-01

    This book presents an intelligent, integrated, problem-independent method for multiresponse process optimization. In contrast to traditional approaches, the idea of this method is to provide a unique model for the optimization of various processes, without imposition of assumptions relating to the type of process, the type and number of process parameters and responses, or interdependences among them. The presented method for experimental design of processes with multiple correlated responses is composed of three modules: an expert system that selects the experimental plan based on the orthogonal arrays; the factor effects approach, which performs processing of experimental data based on Taguchi’s quality loss function and multivariate statistical methods; and process modeling and optimization based on artificial neural networks and metaheuristic optimization algorithms. The implementation is demonstrated using four case studies relating to high-tech industries and advanced, non-conventional processes.

  13. An integrated approach to improving noisy speech perception

    Science.gov (United States)

    Koval, Serguei; Stolbov, Mikhail; Smirnova, Natalia; Khitrov, Mikhail

    2002-05-01

    For a number of practical purposes and tasks, experts have to decode speech recordings of very poor quality. A combination of techniques is proposed to improve intelligibility and quality of distorted speech messages and thus facilitate their comprehension. Along with the application of noise cancellation and speech signal enhancement techniques removing and/or reducing various kinds of distortions and interference (primarily unmasking and normalization in time and frequency fields), the approach incorporates optimal listener expert tactics based on selective listening, nonstandard binaural listening, accounting for short-term and long-term human ear adaptation to noisy speech, as well as some methods of speech signal enhancement to support speech decoding during listening. The approach integrating the suggested techniques ensures high-quality ultimate results and has successfully been applied by Speech Technology Center experts and by numerous other users, mainly forensic institutions, to perform noisy speech records decoding for courts, law enforcement and emergency services, accident investigation bodies, etc.

  14. An integrative approach to research of deforestation under concession management

    International Nuclear Information System (INIS)

    Hepner, G.F.; Walker, R.T.

    1991-01-01

    A methodological approach integrating questionnaire research of tropical foresters with analyses of the actual patterns of concession logging and land use activities portrayed on various types of satellite imagery is discussed. The imagery analysis is necessary to: document the location place and magnitude of forest utilization and change in concession areas; confirm that responses vis-a-vis deforestation in the questionnaire correspond to observable behaviors as evidenced by the actual patterns of logging activities; and document the postharvest land utilization and conversion to other land uses. It is argued that this approach will link the process and pattern of logging activities to reveal the main factors leading to deforestation under the concession system of management. 20 refs

  15. Developing an integrated framework of problem-based learning and coaching psychology for medical education: a participatory research.

    Science.gov (United States)

    Wang, Qing; Li, Huiping; Pang, Weiguo; Liang, Shuo; Su, Yiliang

    2016-01-05

    Medical schools have been making efforts to develop their own problem-based learning (PBL) approaches based on their educational conditions, human resources and existing curriculum structures. This study aimed to explore a new framework by integrating the essential features of PBL and coaching psychology applicable to the undergraduate medical education context. A participatory research design was employed. Four educational psychology researchers, eight undergraduate medical school students and two accredited PBL tutors participated in a four-month research programme. Data were collected through participatory observation, focus groups, semi-structured interviews, workshop documents and feedback surveys and then subjected to thematic content analysis. The triangulation of sources and member checking were used to ensure the credibility and trustworthiness of the research process. Five themes emerged from the analysis: current experience of PBL curriculum; the roles of and relationships between tutors and students; student group dynamics; development of self-directed learning; and coaching in PBL facilitation. On the basis of this empirical data, a systematic model of PBL and coaching psychology was developed. The findings highlighted that coaching psychology could be incorporated into the facilitation system in PBL. The integrated framework of PBL and coaching psychology in undergraduate medical education has the potential to promote the development of the learning goals of cultivating clinical reasoning ability, lifelong learning capacities and medical humanity. Challenges, benefits and future directions for implementing the framework are discussed in this paper.

  16. Medical subdomain classification of clinical notes using a machine learning-based natural language processing approach.

    Science.gov (United States)

    Weng, Wei-Hung; Wagholikar, Kavishwar B; McCray, Alexa T; Szolovits, Peter; Chueh, Henry C

    2017-12-01

    The medical subdomain of a clinical note, such as cardiology or neurology, is useful content-derived metadata for developing machine learning downstream applications. To classify the medical subdomain of a note accurately, we have constructed a machine learning-based natural language processing (NLP) pipeline and developed medical subdomain classifiers based on the content of the note. We constructed the pipeline using the clinical NLP system, clinical Text Analysis and Knowledge Extraction System (cTAKES), the Unified Medical Language System (UMLS) Metathesaurus, Semantic Network, and learning algorithms to extract features from two datasets - clinical notes from Integrating Data for Analysis, Anonymization, and Sharing (iDASH) data repository (n = 431) and Massachusetts General Hospital (MGH) (n = 91,237), and built medical subdomain classifiers with different combinations of data representation methods and supervised learning algorithms. We evaluated the performance of classifiers and their portability across the two datasets. The convolutional recurrent neural network with neural word embeddings trained-medical subdomain classifier yielded the best performance measurement on iDASH and MGH datasets with area under receiver operating characteristic curve (AUC) of 0.975 and 0.991, and F1 scores of 0.845 and 0.870, respectively. Considering better clinical interpretability, linear support vector machine-trained medical subdomain classifier using hybrid bag-of-words and clinically relevant UMLS concepts as the feature representation, with term frequency-inverse document frequency (tf-idf)-weighting, outperformed other shallow learning classifiers on iDASH and MGH datasets with AUC of 0.957 and 0.964, and F1 scores of 0.932 and 0.934 respectively. We trained classifiers on one dataset, applied to the other dataset and yielded the threshold of F1 score of 0.7 in classifiers for half of the medical subdomains we studied. Our study shows that a supervised

  17. Auditory-Verbal Music Play Therapy: An Integrated Approach (AVMPT

    Directory of Open Access Journals (Sweden)

    Sahar Mohammad Esmaeilzadeh

    2013-10-01

    Full Text Available Introduction: Hearing loss occurs when there is a problem with one or more parts of the ear or ears and causes children to have a delay in the language-learning process. Hearing loss affects children's lives and their development. Several approaches have been developed over recent decades to help hearing-impaired children develop language skills. Auditory-verbal therapy (AVT is one such approach. Recently, researchers have found that music and play have a considerable effect on the communication skills of children, leading to the development of music therapy (MT and play therapy (PT. There have been several studies which focus on the impact of music on hearing-impaired children. The aim of this article is to review studies conducted in AVT, MT, and PT and their efficacy in hearing-impaired children. Furthermore, the authors aim to introduce an integrated approach of AVT, MT, and PT which facilitates language and communication skills in hearing-impaired children.   Materials and Methods: In this article we review studies of AVT, MT, and PT and their impact on hearing-impaired children. To achieve this goal, we searched databases and journals including Elsevier, Chor Teach, and Military Psychology, for example. We also used reliable websites such as American Choral Directors Association and Joint Committee on Infant Hearing websites. The websites were reviewed and key words in this article used to find appropriate references. Those articles which are related to ours in content were selected.    Results: Recent technologies have brought about great advancement in the field of hearing disorders. Now these impairments can be detected at birth, and in the majority of cases, hearing impaired children can develop fluent spoken language through audition. According to researches on the relationship between hearing impaired children’s communication and language skills and different approaches of therapy, it is known that learning through listening and

  18. FT. Sam 91 Whiskey Combat Medic Medical Simulation Training Quantitative Integration Enhancement Program

    Science.gov (United States)

    2011-07-01

    task analysis.” In J.M. Spector, M.D. Merrill, J.J.G. van Merrienboer, & M.P. Driscoll (Eds.). Handbook of research on educational communications ...emergency medical care to patrons of large events such as concerts, NBA basketball games, Conventions and many other events in San Antonio. (Contact...from a Bachelor’s Degree in Health and Science with a concentration in sports medicine Volunteered medical oversight for base/ community 5k runs

  19. An integrated Boltzmann+hydrodynamics approach to heavy ion collisions

    Energy Technology Data Exchange (ETDEWEB)

    Petersen, Hannah

    2009-04-22

    In this thesis the first fully integrated Boltzmann+hydrodynamics approach to relativistic heavy ion reactions has been developed. After a short introduction that motivates the study of heavy ion reactions as the tool to get insights about the QCD phase diagram, the most important theoretical approaches to describe the system are reviewed. The hadron-string transport approach that this work is based on is the Ultra-relativistic Quantum Molecular Dynamics (UrQMD) approach. Predictions for the charged particle multiplicities at LHC energies are made. The next step is the development of a new framework to calculate the baryon number density in a transport approach. Time evolutions of the net baryon number and the quark density have been calculated at AGS, SPS and RHIC energies. Studies of phase diagram trajectories using hydrodynamics are performed. The hybrid approach that has been developed as the main part of this thesis is based on the UrQMD transport approach with an intermediate hydrodynamical evolution for the hot and dense stage of the collision. The full (3+1) dimensional ideal relativistic one fluid dynamics evolution is solved using the SHASTA algorithm. Three different equations of state have been used, namely a hadron gas equation of state without a QGP phase transition, a chiral EoS and a bag model EoS including a strong first order phase transition. For the freeze-out transition from hydrodynamics to the cascade calculation two different set-ups are employed. The parameter dependences of the model are investigated and the time evolution of different quantities is explored. The hybrid model calculation is able to reproduce the experimentally measured integrated as well as transverse momentum dependent v{sub 2} values for charged particles. The multiplicity and mean transverse mass excitation function is calculated for pions, protons and kaons in the energy range from E{sub lab}=2-160 A GeV. The HBT correlation of the negatively charged pion source

  20. Evaluation of a teaching strategy based on integration of clinical subjects, virtual autopsy, pathology museum, and digital microscopy for medical students.

    Science.gov (United States)

    Diaz-Perez, Julio A; Raju, Sharat; Echeverri, Jorge H

    2014-01-01

    Learning pathology is fundamental for a successful medical practice. In recent years, medical education has undergone a profound transformation toward the development of an integrated curriculum incorporating both basic science and clinical material. Simultaneously, there has been a shift from a magisterial teaching approach to one centered around problem-based learning. Now-a-days, informatics tools are expected to help better implement these strategies. We applied and evaluated a new teaching method based on an active combination of clinical problems, gross pathology, histopathology, and autopsy pathology, all given through informatics tools, to teach a group of medical students at the Universidad de Santander, Colombia. Ninety-four medical students were followed in two consecutive semesters. Students were randomized to receive teaching either through traditional methodology or through the new integrated approach. There was no significant difference between the intervention group and the control group at baseline. At the end of the study, the scores in the intervention group were significantly higher compared to the control group (3.91/5.0 vs. 3.33/5.0, P = 0.0008). Students and tutors endorsed the benefits of the integrated approach. Participants were very satisfied with this training approach and rated the program an 8.7 out of 10, on average. This study confirms that an integrated curriculum utilizing informatics systems provides an excellent opportunity to associate pathology with clinical medicine early in training of medical students. This can be possible with the use of virtual microscopy and digital imaging.

  1. National standards in pathology education: developing competencies for integrated medical school curricula.

    Science.gov (United States)

    Sadofsky, Moshe; Knollmann-Ritschel, Barbara; Conran, Richard M; Prystowsky, Michael B

    2014-03-01

    Medical school education has evolved from department-specific memorization of facts to an integrated curriculum presenting knowledge in a contextual manner across traditional disciplines, integrating information, improving retention, and facilitating application to clinical practice. Integration occurs throughout medical school using live data-sharing technologies, thereby providing the student with a framework for lifelong active learning. Incorporation of educational teams during medical school prepares students for team-based patient care, which is also required for pay-for-performance models used in accountable care organizations. To develop learning objectives for teaching pathology to medical students. Given the rapid expansion of basic science knowledge of human development, normal function, and pathobiology, it is neither possible nor desirable for faculty to teach, and students to retain, this vast amount of information. Courses teaching the essentials in context and engaging students in the learning process enable them to become lifelong learners. An appreciation of pathobiology and the role of laboratory medicine underlies the modern practice of medicine. As such, all medical students need to acquire 3 basic competencies in pathology: an understanding of disease mechanisms, integration of mechanisms into organ system pathology, and application of pathobiology to diagnostic medicine. We propose the development of 3 specific competencies in pathology to be implemented nationwide, aimed at disease mechanisms/processes, organ system pathology, and application to diagnostic medicine. Each competency will include learning objectives and a means to assess acquisition, integration, and application of knowledge. The learning objectives are designed to be a living document managed (curated) by a group of pathologists representing Liaison Committee on Medical Education-accredited medical schools nationally. Development of a coherent set of learning objectives will

  2. On Line Service Composition in the Integrated Clinical Environment for eHealth and Medical Systems.

    Science.gov (United States)

    García-Valls, Marisol; Touahria, Imad Eddine

    2017-06-08

    Medical and eHealth systems are progressively realized in the context of standardized architectures that support safety and ease the integration of the heterogeneous (and often proprietary) medical devices and sensors. The Integrated Clinical Environment (ICE) architecture appeared recently with the goal of becoming a common framework for defining the structure of the medical applications as concerns the safe integration of medical devices and sensors. ICE is simply a high level architecture that defines the functional blocks that should be part of a medical system to support interoperability. As a result, the underlying communication backbone is broadly undefined as concerns the enabling software technology (including the middleware) and associated algorithms that meet the ICE requirements of the flexible integration of medical devices and services. Supporting the on line composition of services in a medical system is also not part of ICE; however, supporting this behavior would enable flexible orchestration of functions (e.g., addition and/or removal of services and medical equipment) on the fly. iLandis one of the few software technologies that supports on line service composition and reconfiguration, ensuring time-bounded transitions across different service orchestrations; it supports the design, deployment and on line reconfiguration of applications, which this paper applies to service-based eHealth domains. This paper designs the integration between ICE architecture and iLand middleware to enhance the capabilities of ICE with on line service composition and the time-bounded reconfiguration of medical systems based on distributed services. A prototype implementation of a service-based eHealth system for the remote monitoring of patients is described; it validates the enhanced capacity of ICE to support dynamic reconfiguration of the application services. Results show that the temporal cost of the on line reconfiguration of the eHealth application is bounded

  3. Integrated Approach to Reconstruction of Microbial Regulatory Networks

    Energy Technology Data Exchange (ETDEWEB)

    Rodionov, Dmitry A [Sanford-Burnham Medical Research Institute; Novichkov, Pavel S [Lawrence Berkeley National Laboratory

    2013-11-04

    This project had the goal(s) of development of integrated bioinformatics platform for genome-scale inference and visualization of transcriptional regulatory networks (TRNs) in bacterial genomes. The work was done in Sanford-Burnham Medical Research Institute (SBMRI, P.I. D.A. Rodionov) and Lawrence Berkeley National Laboratory (LBNL, co-P.I. P.S. Novichkov). The developed computational resources include: (1) RegPredict web-platform for TRN inference and regulon reconstruction in microbial genomes, and (2) RegPrecise database for collection, visualization and comparative analysis of transcriptional regulons reconstructed by comparative genomics. These analytical resources were selected as key components in the DOE Systems Biology KnowledgeBase (SBKB). The high-quality data accumulated in RegPrecise will provide essential datasets of reference regulons in diverse microbes to enable automatic reconstruction of draft TRNs in newly sequenced genomes. We outline our progress toward the three aims of this grant proposal, which were: Develop integrated platform for genome-scale regulon reconstruction; Infer regulatory annotations in several groups of bacteria and building of reference collections of microbial regulons; and Develop KnowledgeBase on microbial transcriptional regulation.

  4. Patient participation in nursing care on medical wards: An integrative review.

    Science.gov (United States)

    Tobiano, Georgia; Marshall, Andrea; Bucknall, Tracey; Chaboyer, Wendy

    2015-06-01

    Patient participation is a way for patients to engage in their nursing care. In view of the possible link between patient participation and safety, there is a need for an updated review to assess patient participation in nursing care. To investigate patients' and nurses' perceptions of and behaviours towards patient participation in nursing care in the context of hospital medical wards. Integrative review. Three search strategies were employed in August 2013; a computerised database search of Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Medline and PsychINFO; reference lists were hand-searched; and forward citation searching was executed. After reviewing the studies, extracting study data and completing summary tables the methodological quality was assessed using the Mixed-Methods Assessment Tool by two reviewers. Reviewers met then to discuss discrepancies as well as the overall strengths and limitations of the studies. Discrepancies were overcome through consensus or a third reviewer adjudicated the issue. Within and across study analysis and synthesis of the findings sections was undertaken using thematic synthesis. Eight studies met inclusion criteria. Four themes were identified - enacting participation, challenges to participation, promoting participation and types of participation. Most studies included were conducted in Europe. The majority of studies used qualitative methodologies, with all studies sampling patients; nurses were included in three studies. Data were largely collected using self-reported perceptions; two studies included observational data. Methodological issues included a lack of reflexivity, un-validated data collection tools, sampling issues and low response rates. On medical wards, patients and nurses desire, perceive or enact patient participation passively. Challenging factors for patient participation include patients' willingness, nurses' approach and confusion around expectations and roles. Information

  5. Optimizing Groundwater Monitoring Networks Using Integrated Statistical and Geostatistical Approaches

    Directory of Open Access Journals (Sweden)

    Jay Krishna Thakur

    2015-08-01

    Full Text Available The aim of this work is to investigate new approaches using methods based on statistics and geo-statistics for spatio-temporal optimization of groundwater monitoring networks. The formulated and integrated methods were tested with the groundwater quality data set of Bitterfeld/Wolfen, Germany. Spatially, the monitoring network was optimized using geo-statistical methods. Temporal optimization of the monitoring network was carried out using Sen’s method (1968. For geostatistical network optimization, a geostatistical spatio-temporal algorithm was used to identify redundant wells in 2- and 2.5-D Quaternary and Tertiary aquifers. Influences of interpolation block width, dimension, contaminant association, groundwater flow direction and aquifer homogeneity on statistical and geostatistical methods for monitoring network optimization were analysed. The integrated approach shows 37% and 28% redundancies in the monitoring network in Quaternary aquifer and Tertiary aquifer respectively. The geostatistical method also recommends 41 and 22 new monitoring wells in the Quaternary and Tertiary aquifers respectively. In temporal optimization, an overall optimized sampling interval was recommended in terms of lower quartile (238 days, median quartile (317 days and upper quartile (401 days in the research area of Bitterfeld/Wolfen. Demonstrated methods for improving groundwater monitoring network can be used in real monitoring network optimization with due consideration given to influencing factors.

  6. An integrative approach to inferring biologically meaningful gene modules

    Directory of Open Access Journals (Sweden)

    Wang Kai

    2011-07-01

    Full Text Available Abstract Background The ability to construct biologically meaningful gene networks and modules is critical for contemporary systems biology. Though recent studies have demonstrated the power of using gene modules to shed light on the functioning of complex biological systems, most modules in these networks have shown little association with meaningful biological function. We have devised a method which directly incorporates gene ontology (GO annotation in construction of gene modules in order to gain better functional association. Results We have devised a method, Semantic Similarity-Integrated approach for Modularization (SSIM that integrates various gene-gene pairwise similarity values, including information obtained from gene expression, protein-protein interactions and GO annotations, in the construction of modules using affinity propagation clustering. We demonstrated the performance of the proposed method using data from two complex biological responses: 1. the osmotic shock response in Saccharomyces cerevisiae, and 2. the prion-induced pathogenic mouse model. In comparison with two previously reported algorithms, modules identified by SSIM showed significantly stronger association with biological functions. Conclusions The incorporation of semantic similarity based on GO annotation with gene expression and protein-protein interaction data can greatly enhance the functional relevance of inferred gene modules. In addition, the SSIM approach can also reveal the hierarchical structure of gene modules to gain a broader functional view of the biological system. Hence, the proposed method can facilitate comprehensive and in-depth analysis of high throughput experimental data at the gene network level.

  7. Integrated variable projection approach (IVAPA) for parallel magnetic resonance imaging.

    Science.gov (United States)

    Zhang, Qiao; Sheng, Jinhua

    2012-10-01

    Parallel magnetic resonance imaging (pMRI) is a fast method which requires algorithms for the reconstructing image from a small number of measured k-space lines. The accurate estimation of the coil sensitivity functions is still a challenging problem in parallel imaging. The joint estimation of the coil sensitivity functions and the desired image has recently been proposed to improve the situation by iteratively optimizing both the coil sensitivity functions and the image reconstruction. It regards both the coil sensitivities and the desired images as unknowns to be solved for jointly. In this paper, we propose an integrated variable projection approach (IVAPA) for pMRI, which integrates two individual processing steps (coil sensitivity estimation and image reconstruction) into a single processing step to improve the accuracy of the coil sensitivity estimation using the variable projection approach. The method is demonstrated to be able to give an optimal solution with considerably reduced artifacts for high reduction factors and a low number of auto-calibration signal (ACS) lines, and our implementation has a fast convergence rate. The performance of the proposed method is evaluated using a set of in vivo experiment data. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. The meaning of integrated care: a systems approach

    Directory of Open Access Journals (Sweden)

    Lars Edgren

    2008-10-01

    Full Text Available Introduction: Organizations can be regarded as systems. The traditional model of systems views them as machines. This seems to be insufficient when it comes to understanding and organizing complex tasks. To better understand integrated care we should approach organizations as constantly changing living organisms, where many agents are interconnected in so-called Complex Adaptive Systems (CAS. Theory and discussion: The term “complex” emphasizes that the necessary competence to perform a task is not owned by any one part, but comes as a result of co-operation within the system. “Adaptive” means that system change occurs through successive adaptations. A CAS consists of several subsystems called agents, which act in dependence of one another. Examples would be the ant-hill, the human immune defence, the financial market and the surgical operating theatre team. Studying a CAS, the focus is on the interaction and communication between agents. Although these thoughts are not new, the CAS-approach has not yet been widely applied to the management of integrated care. This helps the management to understand why the traditional top down way of managing, following the machine model thinking, may meet with problems in interdependent organizations with complex tasks. Conclusion: When we perceive health and social services as CASs we should gain more insight into the processes that go on within and between organizations and how top management, for example within a hospital, in fact executes its steering function.

  9. An integrated systems engineering approach to aircraft design

    Science.gov (United States)

    Price, M.; Raghunathan, S.; Curran, R.

    2006-06-01

    The challenge in Aerospace Engineering, in the next two decades as set by Vision 2020, is to meet the targets of reduction of nitric oxide emission by 80%, carbon monoxide and carbon dioxide both by 50%, reduce noise by 50% and of course with reduced cost and improved safety. All this must be achieved with expected increase in capacity and demand. Such a challenge has to be in a background where the understanding of physics of flight has changed very little over the years and where industrial growth is driven primarily by cost rather than new technology. The way forward to meet the challenges is to introduce innovative technologies and develop an integrated, effective and efficient process for the life cycle design of aircraft, known as systems engineering (SE). SE is a holistic approach to a product that comprises several components. Customer specifications, conceptual design, risk analysis, functional analysis and architecture, physical architecture, design analysis and synthesis, and trade studies and optimisation, manufacturing, testing validation and verification, delivery, life cycle cost and management. Further, it involves interaction between traditional disciplines such as Aerodynamics, Structures and Flight Mechanics with people- and process-oriented disciplines such as Management, Manufacturing, and Technology Transfer. SE has become the state-of-the-art methodology for organising and managing aerospace production. However, like many well founded methodologies, it is more difficult to embody the core principles into formalised models and tools. The key contribution of the paper will be to review this formalisation and to present the very latest knowledge and technology that facilitates SE theory. Typically, research into SE provides a deeper understanding of the core principles and interactions, and helps one to appreciate the required technical architecture for fully exploiting it as a process, rather than a series of events. There are major issues as

  10. Integrated system approach for increase of engine combined cycle efficiency

    International Nuclear Information System (INIS)

    Gewald, D.; Karellas, S.; Schuster, A.; Spliethoff, H.

    2012-01-01

    Highlights: ► A new approach for the optimization of engine combined cycle systems is presented. ► The efficiency can be increased by integrating all available waste heat sources. ► The optimization of the ICE cooling system towards higher temperatures is examined. ► Higher engine cooling water temperatures increase the combined cycle efficiency. ► The costs of electricity generation can be decreased by five integrated system. - Abstract: Internal combustion engines (ICEs) are widely used as independent power producers due to their high electrical efficiency (up to 47%), which can be further enhanced by operating them in combined cycle mode with a water/steam cycle as bottoming cycle. This study presents an integrated approach to optimize the combined cycle overall system efficiency. Therefore, not only the most favorable design of the waste heat recovery (WHR) cycle, but also the optimal configuration of the ICE cooling system have to be investigated, in order to integrate both available engine waste heat sources (exhaust gas, 300–400 °C, engine cooling water, 90 °C) into the waste heat recovery cycle. For the definition of the most favourable temperature level of the engine cooling water three variants of engine cooling systems are examined, with respect to technical limitations given by the ICE. In order to determine the types of engines for which this optimization approach is suitable, three types of engines with different characteristics (fuel, exhaust gas parameters) combined with a water/steam cycle are simulated, by using the calculation tools Excel and Ebsilon Professional. An energetic, exergetic and economic analysis is conducted. These reveal the impacts of the temperature level to the WHR system and to the design of the engine cooling system. The calculations performed, showed that up to 19% of the engine cooling water heat can be efficiently recovered compared to a portion of 6% in the standard system. The better recovery leads to a 5

  11. Approach to syncope in the era of medical technology.

    Science.gov (United States)

    Sakr, Antoine; Sreih, Antoine

    2007-02-01

    Syncope is a common medical condition that continues to challenge residents and specialists. It is responsible for 6% of general medical admissions and imposes a financial burden for unnecessary tests up to $16,000 per patient. Because of its disabling potential and lack of a "gold standard" test, syncope often leads to multiple hospital admissions and to the performance of many tests thought to be useful in diagnosis. Our survey consisted of a series of medical questions aimed at assessing the medical knowledge among nurses, residents and cardiologists. Despite the frequency of syncope, our survey showed a lack of medical knowledge among nurses, residents and cardiologists. It is hoped that improving medical knowledge will allow appropriate tailoring of the workup for syncope and reduce the cost of admissions to the hospital for this condition.

  12. Challenges and opportunities for integrating lake ecosystem modelling approaches

    Science.gov (United States)

    Mooij, Wolf M.; Trolle, Dennis; Jeppesen, Erik; Arhonditsis, George; Belolipetsky, Pavel V.; Chitamwebwa, Deonatus B.R.; Degermendzhy, Andrey G.; DeAngelis, Donald L.; Domis, Lisette N. De Senerpont; Downing, Andrea S.; Elliott, J. Alex; Ruberto, Carlos Ruberto; Gaedke, Ursula; Genova, Svetlana N.; Gulati, Ramesh D.; Hakanson, Lars; Hamilton, David P.; Hipsey, Matthew R.; Hoen, Jochem 't; Hulsmann, Stephan; Los, F. Hans; Makler-Pick, Vardit; Petzoldt, Thomas; Prokopkin, Igor G.; Rinke, Karsten; Schep, Sebastiaan A.; Tominaga, Koji; Van Dam, Anne A.; Van Nes, Egbert H.; Wells, Scott A.; Janse, Jan H.

    2010-01-01

    A large number and wide variety of lake ecosystem models have been developed and published during the past four decades. We identify two challenges for making further progress in this field. One such challenge is to avoid developing more models largely following the concept of others ('reinventing the wheel'). The other challenge is to avoid focusing on only one type of model, while ignoring new and diverse approaches that have become available ('having tunnel vision'). In this paper, we aim at improving the awareness of existing models and knowledge of concurrent approaches in lake ecosystem modelling, without covering all possible model tools and avenues. First, we present a broad variety of modelling approaches. To illustrate these approaches, we give brief descriptions of rather arbitrarily selected sets of specific models. We deal with static models (steady state and regression models), complex dynamic models (CAEDYM, CE-QUAL-W2, Delft 3D-ECO, LakeMab, LakeWeb, MyLake, PCLake, PROTECH, SALMO), structurally dynamic models and minimal dynamic models. We also discuss a group of approaches that could all be classified as individual based: super-individual models (Piscator, Charisma), physiologically structured models, stage-structured models and trait-based models. We briefly mention genetic algorithms, neural networks, Kalman filters and fuzzy logic. Thereafter, we zoom in, as an in-depth example, on the multi-decadal development and application of the lake ecosystem model PCLake and related models (PCLake Metamodel, Lake Shira Model, IPH-TRIM3D-PCLake). In the discussion, we argue that while the historical development of each approach and model is understandable given its 'leading principle', there are many opportunities for combining approaches. We take the point of view that a single 'right' approach does not exist and should not be strived for. Instead, multiple modelling approaches, applied concurrently to a given problem, can help develop an integrative

  13. An approach to human-centered design of nuclear medical equipment: the system of caption of the thyroid

    International Nuclear Information System (INIS)

    Santos, Isaac J.A. Luquetti; Silva, Carlos Borges da; Santana, Marcos; Carvalho, Paulo Victor R.; Oliveira, Mauro Vitor de; Mol, Antonio Carlos Mol; Grecco, Claudio Henrique; Augusto, Silas Cordeiro

    2005-01-01

    Technology plays an important role in modern medical centers, making health care increasingly complex, relying on complex technical equipment. This technical complexity is particularly noticeable in the nuclear medicine and can increase the risks for human error. Human error has many causes such as performance shaping factors, organizational factors and user interface design. Poorly design human system interfaces of nuclear medical equipment can increase the risks for human error. If all nuclear medical equipment had been designed with good user interfaces, incidents and accidents could be reduced as well as he time required to learn how to use the equipment. Although some manufacturers of nuclear medical equipment have already integrate human factors principles in their products, there is still a need to steer the development of nuclear medical technology toward more human-centered approach. The aim of this paper is to propose a methodology that contributes to the design, development and evaluation of nuclear medical equipment and human system interface, towards a human-centered approach. This methodology includes the ergonomic approach, based on the operator activity analysis, together with human factors standards and guidelines, questionnaires and user based testing. We describe a case study in which this methodology is being applied in evaluation of the thyroid uptake system, getting essential information and data, that ill be used in development of a new system. (author)

  14. Integrating Social Determinants of Health Into Graduate Medical Education: A Call for Action.

    Science.gov (United States)

    Siegel, Jennifer; Coleman, David L; James, Thea

    2018-02-01

    Social determinants of health (SDH) are the major drivers of health and disparate health outcomes across communities and populations. Given this, the authors assert that competency in recognizing and mitigating SDH should become a vital component of graduate medical education in all specialties. Although the most effective approaches to educating trainees about SDH are uncertain, in this Invited Commentary, the authors offer several key principles for implementing curricula focusing on SDH. These include universalization of the material, integration into clinical education, identification of space for trainee introspection, clarification of specific competencies in identification and mitigation of SDH, and creation of robust faculty development programming. The authors highlight several examples of curricular approaches to SDH, touching on orientation, experiential learning, community-based and service-learning opportunities, interprofessional activities, and the hidden curriculum. The authors argue that all clinical trainees must learn to recognize and mitigate SDH and that doing so will allow them to achieve meaning and mastery in medicine and to better meet society's pressing health needs.

  15. Keeping the medical practice financially viable: a marketer's approach.

    Science.gov (United States)

    Patrick, Michelle L; Capraro, Anthony J; Credito, Candace M

    2002-01-01

    This paper explores a way that medical practices might develop a higher margin revenue source by offering a differentiated service that caters to patients who value more personalized service. Using SERVQUAL, German patients were surveyed to determine if there is a relationship between a desire for personalized service and a willingness to pay a premium for medical care. The results indicate that a greater desire for personalized care distinguishes those who pay a premium for medical care from those who do not. This suggests that medical practices can differentiate their service based on more personalized care and charge a higher fee for this service.

  16. A high performance parallel approach to medical imaging

    International Nuclear Information System (INIS)

    Frieder, G.; Frieder, O.; Stytz, M.R.

    1988-01-01

    Research into medical imaging using general purpose parallel processing architectures is described and a review of the performance of previous medical imaging machines is provided. Results demonstrating that general purpose parallel architectures can achieve performance comparable to other, specialized, medical imaging machine architectures is presented. A new back-to-front hidden-surface removal algorithm is described. Results demonstrating the computational savings obtained by using the modified back-to-front hidden-surface removal algorithm are presented. Performance figures for forming a full-scale medical image on a mesh interconnected multiprocessor are presented

  17. Medical egg freezing: the importance of a patient-centered approach to fertility preservation.

    Science.gov (United States)

    Inhorn, Marcia C; Birenbaum-Carmeli, Daphna; Westphal, Lynn M; Doyle, Joseph; Gleicher, Norbert; Meirow, Dror; Raanani, Hila; Dirnfeld, Martha; Patrizio, Pasquale

    2018-01-01

    This binational qualitative study of medical egg freezing (MEF) examined women's motivations and experiences, including their perceived needs for patient-centered care in the midst of fertility- and life-threatening diagnoses. Forty-five women who had undertaken MEF were interviewed in the USA (33 women) and in Israel (12 women) between June 2014 and August 2016. Interviews lasted approximately 1 h and were conducted by two senior medical anthropologists, one in each country. Women were recruited from four American IVF clinics (two academic, two private) and two Israeli clinics (both academic) where MEF is being offered to cancer patients and women with other fertility-threatening medical conditions. Women who undertake MEF view their fertility and future motherhood as important components of their identities and recovery and, thus, are grateful for the opportunity to pursue fertility preservation. However, women who undergo MEF have special needs, given that they tend to be a "vulnerable" population of young (age preservation, including five "system factors" (information, coordination and integration, accessibility, physical comfort, cost) and five "human factors" (adolescent issues, male partner involvement, family involvement, egg disposition decisions, emotional support). Together, these dimensions of care constitute an important framework that can be best described as "patient-centered MEF." Women pursuing MEF have special medical needs and concerns, which require particular forms of patient-centered care. This study outlines 10 dimensions of patient-centered fertility preservation that are appropriate for MEF patients. This approach may help IVF clinics to be better prepared for delivering top-quality care to mostly young, single women facing the daunting prospect of fertility loss and life-threatening medical diagnoses.

  18. Socially Accountable Medical Education: An Innovative Approach at Florida International University Herbert Wertheim College of Medicine.

    Science.gov (United States)

    Greer, Pedro J; Brown, David R; Brewster, Luther G; Lage, Onelia G; Esposito, Karin F; Whisenant, Ebony B; Anderson, Frederick W; Castellanos, Natalie K; Stefano, Troy A; Rock, John A

    2018-01-01

    Despite medical advances, health disparities persist, resulting in medicine's renewed emphasis on the social determinants of health and calls for reform in medical education. The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP) at Herbert Wertheim College of Medicine provides a platform for the school's community-focused mission. NeighborhoodHELP emphasizes social accountability and interprofessional education while providing evidence-based, patient- and household-centered care. NeighborhoodHELP is a required, longitudinal service-learning outreach program in which each medical student is assigned a household in a medically underserved community. Students, teamed with learners from other professional schools, provide social and clinical services to their household for three years. Here the authors describe the program's engagement approach, logistics, and educational goals and structure. During the first six years of NeighborhoodHELP (September 2010-August 2016), 1,470 interprofessional students conducted 7,452 visits to 848 households with, collectively, 2,252 members. From August 2012, when mobile health centers were added to the program, through August 2016, students saw a total of 1,021 household members through 7,207 mobile health center visits. Throughout this time, households received a variety of free health and social services (e.g., legal aid, tutoring). Compared with peers from other schools, graduating medical students reported more experience with clinical interprofessional education and health disparities. Surveyed residency program directors rated graduates highly for their cultural sensitivity, teamwork, and accountability. Faculty and administrators are focusing on social accountability curriculum integration, systems for assessing and tracking relevant educational and household outcomes, and policy analysis.

  19. Ayurveda education: Evaluating the integrative approaches of teaching Kriya Sharira (Ayurveda physiology

    Directory of Open Access Journals (Sweden)

    Himanshu Joshi

    2013-01-01

    Full Text Available Background: ′What is the ideal way of teaching Ayurveda?′ - has been a debated question since long. The present graduate level curriculum lists out the topics from ′contemporary medical science′ and ′Ayurveda′ discretely, placing no emphasis on integration. Most of the textbooks, too, follow the same pattern. This makes learning not only difficult, but also leads to cognitive dissonance. Objectives: To develop and evaluate the effectiveness of a few integrative teaching methods. Materials and Methods: We introduced three different interventions in the subject Kriya Sharira with special reference to ′cardiovascular physiology′. The instructional methods that we evaluated were: 1. Integrative module on cardiovascular physiology (IMCP, 2. case-stimulated learning (CSL, and 3. classroom small group discussion (CSGD. In the first two experiments, we subjected the experimental group of graduate students to the integrative instructional methods. The control group of students received the instructions in a conventional, didactic, teacher-centric way. After the experiments were over, the learning outcome was assessed and compared on the basis of the test scores. The groups were crossed over thereafter and the instructional methods were interchanged. Finally, feedback was obtained on different questionnaires. In the third experiment, only student feedback was taken as we could not have a control group. Results: The test results in the first experiment showed that the integrative method is comparable with the conventional method. In the second experiment, the test results showed that the integrative method is better than the conventional method. The student feedback showed that all the three methods were perceived to be more interesting than the conventional one. Conclusion: The study shows that the development of testable integrative teaching methods is possible in the context of Ayurveda education. It also shows that students find

  20. Integrated modular teaching in dermatology for undergraduate students: A novel approach

    Directory of Open Access Journals (Sweden)

    Kaliaperumal Karthikeyan

    2014-01-01

    Full Text Available Context: Undergraduate teaching in dermatology comprises didactic lectures and clinical classes. Integrated modular teaching is a novel approach, which integrates basic sciences with dermatology in the form of a module. Further the module also incorporates various teaching modalities, which facilitate active participation from students and promotes learning. The pre- and post-test values showed the effectiveness of the integrated module. The students feedback was encouraging. Aims: The aim of this study was to determine the acceptance and opinion of undergraduate students regarding integrated modular teaching as a new teaching aid in dermatology. Settings and Design: This was a descriptive study. Varied teaching methodologies involving multiple disciplines were undertaken in six major undergraduate topics in dermatology for seventh and eighth semester students. Materials and Methods: A total of six modules were conducted over a period of 12 months for students of seventh and eighth semesters. The topics for the various modules were sexually transmitted diseases, acquired immunodeficiency syndrome, oral ulcers, leprosy, connective tissue disorders and psoriasis. Faculty members from different disciplines participated. Pre- and post-test were conducted before and after the modules respectively to gauge the effectiveness of the modules. Results: It was found that almost every student had a better score on the posttest as compared to the pretest. General feedback obtained from the students showed that all of them felt that modular teaching was a more interesting and useful teaching learning experience than conventional teaching. Conclusions: Integrated modular teaching can be an effective adjunct in imparting theoretical and practical knowledge to the students. Further, various teaching methodologies can be used in integrated modules effectively with active student participation. Thus integrated modular teaching addresses two important issues in

  1. Vertically-integrated Approaches for Carbon Sequestration Modeling

    Science.gov (United States)

    Bandilla, K.; Celia, M. A.; Guo, B.

    2015-12-01

    Carbon capture and sequestration (CCS) is being considered as an approach to mitigate anthropogenic CO2 emissions from large stationary sources such as coal fired power plants and natural gas processing plants. Computer modeling is an essential tool for site design and operational planning as it allows prediction of the pressure response as well as the migration of both CO2 and brine in the subsurface. Many processes, such as buoyancy, hysteresis, geomechanics and geochemistry, can have important impacts on the system. While all of the processes can be taken into account simultaneously, the resulting models are computationally very expensive and require large numbers of parameters which are often uncertain or unknown. In many cases of practical interest, the computational and data requirements can be reduced by choosing a smaller domain and/or by neglecting or simplifying certain processes. This leads to a series of models with different complexity, ranging from coupled multi-physics, multi-phase three-dimensional models to semi-analytical single-phase models. Under certain conditions the three-dimensional equations can be integrated in the vertical direction, leading to a suite of two-dimensional multi-phase models, termed vertically-integrated models. These models are either solved numerically or simplified further (e.g., assumption of vertical equilibrium) to allow analytical or semi-analytical solutions. This presentation focuses on how different vertically-integrated models have been applied to the simulation of CO2 and brine migration during CCS projects. Several example sites, such as the Illinois Basin and the Wabamun Lake region of the Alberta Basin, are discussed to show how vertically-integrated models can be used to gain understanding of CCS operations.

  2. EAU standardised medical terminology for urologic imaging: a taxonomic approach.

    Science.gov (United States)

    Loch, Tillmann; Carey, Brendan; Walz, Jochen; Fulgham, Pat Fox

    2015-05-01

    The terminology and abbreviations used in urologic imaging have generally been adopted on an ad hoc basis by different speciality groups; however, there is a need for shared nomenclature to facilitate clinical communication and collaborative research. This work reviews the current nomenclature for urologic imaging used in clinical practice and proposes a taxonomy and terminology for urologic imaging studies. A list of terms used in urologic imaging were compiled from guidelines published by the European Association of Urology and the American Urological Association and from the American College of Radiology Appropriateness Criteria. Terms searched were grouped into broad categories based on technology, and imaging terms were further stratified based on the anatomic extent, contrast or phases, technique or modifiers, and combinations or fusions. Terms that had a high degree of utilisation were classified as accepted. We propose a new taxonomy to define a more useful and acceptable nomenclature model acceptable to all health professionals involved in urology. The major advantage of a taxonomic approach to the classification of urologic imaging studies is that it provides a flexible framework for classifying the modifications of current imaging modalities and allows the incorporation of new imaging modalities. The adoption of this hierarchical classification model ranging from the most general to the most detailed descriptions should facilitate hierarchical searches of the medical literature using both general and specific terms. This work is limited in its scope, as it is not currently all-inclusive. This will hopefully be addressed by future modification as others embrace the concept and work towards uniformity in nomenclature. This paper provides a noncomprehensive list of the most widely used terms across different specialties. This list can be used as the basis for further discussion, development, and enhancement. In this paper we describe a classification system

  3. Integrating geriatrics into medical school: student journaling as an innovative strategy for evaluating curriculum.

    Science.gov (United States)

    Shield, Renée R; Farrell, Timothy W; Nanda, Aman; Campbell, Susan E; Wetle, Terrie

    2012-02-01

    The Alpert Medical School of Brown University began to integrate geriatrics content into all preclerkship courses and key clerkship cases as part of a major medical school curriculum redesign in 2006. This study evaluates students' responses to geriatrics integration within the curriculum using journals kept by volunteer preclerkship and clerkship students between 2007 and 2010. The journals were used to assess the quality of curricular integration of geriatrics didactic and clinical content, to gather information for shaping the evolving curriculum, and to elicit students' responses about their professional development and caring for older adults. Student "journalers" wrote narrative reactions to and evaluations of aging-related content and exposure to older patients in response to written semistructured questions. An interdisciplinary team (including a health services researcher, gerontologist, medical anthropologist, and 2 geriatricians) used qualitative analysis to code the 405 journal entries. The team identified 10 themes within the following domains: (a) evaluation of efforts to integrate geriatrics within the medical school curriculum, (b) recognition and application of geriatrics principles, (c) student attitudes and cultural experiences regarding aging and the care of older patients, and (d) personal and professional development over time. Themes emerging within these domains reflect the effectiveness of geriatrics integration within the new curriculum as well as students' professional development. Journaling provides a novel and effective method for capturing medical students' responses to curricular content in real time, allowing for midcourse corrections and identifying key components of their professional development.

  4. A Multidisciplinary Approach to Sexual Dysfunction in Medical Education

    Science.gov (United States)

    Foley, Sallie; Wittmann, Daniela; Balon, Richard

    2010-01-01

    Objective: Addressing sexual health concerns in medical practice has been an emerging concept for the past two decades. However, there have been very few educational opportunities in medical training that would prepare future physicians for such a responsibility. Since assessing and treating sexual problems requires knowledge that encompasses many…

  5. Selecting Students for Medical Education : Exploring novel approaches

    NARCIS (Netherlands)

    S.M. Lucieer (Susanna)

    2016-01-01

    markdownabstractAbstract Medical schools all over the world have to select their students as the number of applicants highly exceeds the number of places available. In this dissertation, we examined why the current selection method employed by Erasmus MC Medical School is successful in

  6. Radioprotection in the medical sector: a new quality approach

    International Nuclear Information System (INIS)

    Prevot, S.

    2008-01-01

    The author describes how quality assurance is organized in the field of radioprotection in the Georges-Francois-Leclerc medical centre in Dijon. She also recalls how this organization has recently evolved because of legal but also technical and technological evolutions. She indicates the main attributions and missions of the radiation protection expert in this medical centre

  7. Telemedicine and EHR Integrated Approach for An Effective E-Governance Healthcare Framework

    Directory of Open Access Journals (Sweden)

    Alpana Kakkar

    2017-05-01

    Full Text Available In the recent years, people have been more inclined towards the use of technology to reduce human effort. Telemedicine is one such concept which has gained popularity among the people, providing them easy access to health care. Telemedicine refers to the concept of providing health care from a distance through an integrated approach using information and communication technology (ICT. India, being a geographically wide country has its difficulties when it comes to providing health care facilities to people belonging to the different regions. This is one of the few reasons why India is the best stage to introduce a concept like telemedicine. The use of this technology to counter the various challenges has been highly regarded and termed as something which can revolutionize the medical field. Integrating telemedicine with electronic health record (EHR, which is a digital document of a person’s medical history is said to be a perfect combination which can help improve clinical efficiency. The country has seen initiatives taken up by various organizations, with the main motive of connecting the rural to the urban. Through this paper, we have discussed the potential we have with this technology, and also propose an EHR integrated telemedicine model to make the best use of it in an emergency healthcare situation to help save lives. We have also touched a few factors which can help the government better the current health scenario.

  8. Towards a Unified Approach to Information Integration - A review paper on data/information fusion

    Energy Technology Data Exchange (ETDEWEB)

    Whitney, Paul D.; Posse, Christian; Lei, Xingye C.

    2005-10-14

    Information or data fusion of data from different sources are ubiquitous in many applications, from epidemiology, medical, biological, political, and intelligence to military applications. Data fusion involves integration of spectral, imaging, text, and many other sensor data. For example, in epidemiology, information is often obtained based on many studies conducted by different researchers at different regions with different protocols. In the medical field, the diagnosis of a disease is often based on imaging (MRI, X-Ray, CT), clinical examination, and lab results. In the biological field, information is obtained based on studies conducted on many different species. In military field, information is obtained based on data from radar sensors, text messages, chemical biological sensor, acoustic sensor, optical warning and many other sources. Many methodologies are used in the data integration process, from classical, Bayesian, to evidence based expert systems. The implementation of the data integration ranges from pure software design to a mixture of software and hardware. In this review we summarize the methodologies and implementations of data fusion process, and illustrate in more detail the methodologies involved in three examples. We propose a unified multi-stage and multi-path mapping approach to the data fusion process, and point out future prospects and challenges.

  9. Integrative Review of Mobile Phone Contacts and Medication Adherence in Severe Mental Illness.

    Science.gov (United States)

    Bright, Cordellia E

    2018-02-01

    Poor medication adherence is a significant problem in individuals with severe mental illness (SMI). About 50% of people with SMI become nonadherent to treatment in the first month following discharge from the hospital. This study examined literature in the past decade (2006-2016) on the use of mobile phone contacts in individuals with SMI to improve medication adherence post hospital discharge. This integrative review used the search terms texting, text messaging, SMS, cell/mobile phone, medication adherence, medication compliance, and mental illness. Databases (CINAHL, PubMed, PsycINFO, and Scopus) and manual searching of reference lists were done. The main inclusion criteria were the use of mobile phone contacts on medication adherence in individuals with SMI. Adults 18 years and older, studies conducted from 2006 to 2016, and studies conducted in English were also criteria for inclusion. Only five studies met criteria for inclusion. Outcomes from the review showed that mobile phone contacts have been used to improve medication adherence in individuals with SMI and able to provide the four types of social support (instrumental, informational, emotional, and, appraisal). When phone contacts especially text messaging was used as an adjunct to other interventions, it yielded better medication adherence than when used alone. However, results on medication adherence rates were mixed in participants on both psychiatric and nonpsychiatric medications. Although mobile phone contacts are a promising tool to enhance medication adherence after hospital discharge, its effectiveness to increase medication adherence in this population remains inconclusive.

  10. Medical Updates Number 5 to the International Space Station Probability Risk Assessment (PRA) Model Using the Integrated Medical Model

    Science.gov (United States)

    Butler, Doug; Bauman, David; Johnson-Throop, Kathy

    2011-01-01

    The Integrated Medical Model (IMM) Project has been developing a probabilistic risk assessment tool, the IMM, to help evaluate in-flight crew health needs and impacts to the mission due to medical events. This package is a follow-up to a data package provided in June 2009. The IMM currently represents 83 medical conditions and associated ISS resources required to mitigate medical events. IMM end state forecasts relevant to the ISS PRA model include evacuation (EVAC) and loss of crew life (LOCL). The current version of the IMM provides the basis for the operational version of IMM expected in the January 2011 timeframe. The objectives of this data package are: 1. To provide a preliminary understanding of medical risk data used to update the ISS PRA Model. The IMM has had limited validation and an initial characterization of maturity has been completed using NASA STD 7009 Standard for Models and Simulation. The IMM has been internally validated by IMM personnel but has not been validated by an independent body external to the IMM Project. 2. To support a continued dialogue between the ISS PRA and IMM teams. To ensure accurate data interpretation, and that IMM output format and content meets the needs of the ISS Risk Management Office and ISS PRA Model, periodic discussions are anticipated between the risk teams. 3. To help assess the differences between the current ISS PRA and IMM medical risk forecasts of EVAC and LOCL. Follow-on activities are anticipated based on the differences between the current ISS PRA medical risk data and the latest medical risk data produced by IMM.

  11. An integrated approach to determine phenomenological equations in metallic systems

    Science.gov (United States)

    Ghamarian, Iman

    It is highly desirable to be able to make predictions of properties in metallic materials based upon the composition of the material and the microstructure. Unfortunately, the complexity of real, multi-component, multi-phase engineering alloys makes the provision of constituent-based (i.e., composition or microstructure) phenomenological equations extremely difficult. Due to these difficulties, qualitative predictions are frequently used to study the influence of microstructure or composition on the properties. Neural networks were used as a tool to get a quantitative model from a database. However, the developed model is not a phenomenological model. In this study, a new method based upon the integration of three separate modeling approaches, specifically artificial neural networks, genetic algorithms, and monte carlo was proposed. These three methods, when coupled in the manner described in this study, allows for the extraction of phenomenological equations with a concurrent analysis of uncertainty. This approach has been applied to a multi-component, multi-phase microstructure exhibiting phases with varying spatial and morphological distributions. Specifically, this approach has been applied to derive a phenomenological equation for the prediction of yield strength in alpha+beta processed Ti-6-4. The equation is consistent with not only the current dataset but also, where available, the limited information regarding certain parameters such as intrinsic yield strength of pure hexagonal close-packed alpha titanium.

  12. Contingent approach to Internet-based supply network integration

    Science.gov (United States)

    Ho, Jessica; Boughton, Nick; Kehoe, Dennis; Michaelides, Zenon

    2001-10-01

    The Internet is playing an increasingly important role in enhancing the operations of supply networks as many organizations begin to recognize the benefits of Internet- enabled supply arrangements. However, the developments and applications to-date do not extend significantly beyond the dyadic model, whereas the real advantages are to be made with the external and network models to support a coordinated and collaborative based approach. The DOMAIN research group at the University of Liverpool is currently defining new Internet- enabled approaches to enable greater collaboration across supply chains. Different e-business models and tools are focusing on different applications. Using inappropriate e- business models, tools or techniques will bring negative results instead of benefits to all the tiers in the supply network. Thus there are a number of issues to be considered before addressing Internet based supply network integration, in particular an understanding of supply chain management, the emergent business models and evaluating the effects of deploying e-business to the supply network or a particular tier. It is important to utilize a contingent approach to selecting the right e-business model to meet the specific supply chain requirements. This paper addresses the issues and provides a case study on the indirect materials supply networks.

  13. Integrating software into PRA: a test-based approach.

    Science.gov (United States)

    Li, Bin; Li, Ming; Smidts, Carol

    2005-08-01

    Probabilistic risk assessment (PRA) is a methodology to assess the probability of failure or success of a system's operation. PRA has been proved to be a systematic, logical, and comprehensive technique for risk assessment. Software plays an increasing role in modern safety critical systems. A significant number of failures can be attributed to software failures. Unfortunately, current probabilistic risk assessment concentrates on representing the behavior of hardware systems, humans, and their contributions (to a limited extent) to risk but neglects the contributions of software due to a lack of understanding of software failure phenomena. It is thus imperative to consider and model the impact of software to reflect the risk in current and future systems. The objective of our research is to develop a methodology to account for the impact of software on system failure that can be used in the classical PRA analysis process. A test-based approach for integrating software into PRA is discussed in this article. This approach includes identification of software functions to be modeled in the PRA, modeling of the software contributions in the ESD, and fault tree. The approach also introduces the concepts of input tree and output tree and proposes a quantification strategy that uses a software safety testing technique. The method is applied to an example system, PACS.

  14. Integrating the art and science of medical practice: innovations in teaching medical communication skills.

    Science.gov (United States)

    Haq, Cynthia; Steele, David J; Marchand, Lucille; Seibert, Christine; Brody, David

    2004-01-01

    This paper describes the content and methods used to teach communication skills in Undergraduate Medical Education for the 21st Century (UME-21) schools and provides suggestions for future efforts. Faculty leaders of curriculum projects at UME-21 schools provided reports describing new communication curriculum projects. Reports were reviewed and analyzed, curriculum content and methods were categorized into themes, and findings were confirmed through phone interviews with lead faculty at each participating school. Curriculum projects were designed to improve medical students' communication skills during the clerkship years at 12 participating UME-21 schools. These skills were addressed through a variety of teaching methods and applied in interactions with patients, health teams, and community members. Curricular themes included conflict resolution, delivery of bad news, addressing patient preferences for end-of-life care, patient and community health education, communicating with families, and working effectively with patients from diverse backgrounds. Students' communication skill competencies were assessed through a variety of methods including objective structured clinical examinations, focused observation and feedback, and debriefing sessions based on recall, audiotapes, or videotapes of encounters. Opportunities for students to develop, apply, and refine their communication skills can be embedded throughout the medical school curricula. Our findings illustrate the variety of methods that may be used to teach and evaluate medical students' communication skill competencies. Future challenges include development of comprehensive longitudinal curricula, practical teaching methods, valid evaluation tools, and faculty development.

  15. Improving written and verbal communication skills for international medical graduates: a linguistic and medical approach.

    Science.gov (United States)

    Cross, Duncan; Smalldridge, Ann

    2011-01-01

    Adapting to UK communication styles can be difficult for International Medical Graduates (IMGs). Reache Northwest provides education, training and support for internationally trained refugee and asylum seeking health professionals who are looking to return to work in the UK. A Safe and Effective Communication Skills course was designed by a team of language teachers and clinicians to provide IMGs with an understanding of the written, verbal and summarisation skills required in the UK work environment. A series of language exercises adapted to clinical situations was developed. These increased in complexity to the practical application of language skills in clinical settings using simulated patients. The combination of language and clinical tutors meant that feedback could be given from a language teacher's perspective, the clinical perspective and the cultural context. The combination of language and clinical tutors meant that analysis of communication difficulties could be made from different perspectives and detailed, specific feedback could be given to each student in these areas. Using a combined linguistic and clinical approach can provide solutions to clinical communication problems that may otherwise be missed. This strategy could be extended to cover communication areas in other contexts.

  16. Conducting Integrated Objective Structured Clinical Examination: Experiences at KIST Medical College, Nepal

    Directory of Open Access Journals (Sweden)

    Rano Mal Piryani

    2013-01-01

    Full Text Available Background: Objective structured clinical examination (OSCE, an important tool for assessment of clinical skills, introduced more than 4 decades ago. KIST Medical College, a new medical school of Nepal, affiliated to Tribhuvan University Institute of Medicine, has made learning of physical examination skills structured and integrated with greater involvement of different clinical science departments. Students learn physical examination skills in second year MBBS as a part of early clinical exposure. Objective: To share the experiences regarding implementation of integrated OSCE. Materials and Methods: At the end of clinical posting of learning of physical examination skills, assessment was done with OSCE. Fifteen OSCE stations including each of 5 minutes were developed and arranged. Standardized patients and validated checklist were used. OSCE was conducted in novel way. Prior to the OSCE session: Suitable venue was selected, assessors were identified, standardized patients were selected, running order of the stations in circuit was developed, list of equipments/instruments required was prepared, and tasks, checklists, feedback questionnaires were printed. The day before the OSCE session: OSCE stations were inspected and clearly labeled, condition of required equipments/instruments was checked, a pack of the documents for each OSCE station were made available, and signs were displayed at proper places. On the day of the OSCE session: Reliable stop watch and loud manual bell were used, support staffs were placed to direct the candidates, examiners, and standardized patients (SPs, assessors explained SPs, students were briefed, supervisors observed the session, and feedback were taken from students, assessors, and SPs. At the end of the OSCE session: Checklists and feedback questionnaires were collected, token money was paid to SPs, and a contribution of everyone was appreciated. After the OSCE session: Score was compiled and result declared, and

  17. Integration of gross anatomy in an organ system-based medical curriculum: strategies and challenges.

    Science.gov (United States)

    Brooks, William S; Woodley, Kristina T C Panizzi; Jackson, James R; Hoesley, Craig J

    2015-01-01

    The University of Alabama School of Medicine (UASOM) instituted a fully integrated, organ system-based preclinical curriculum in 2007. Gross anatomy and embryology were integrated with other basic science disciplines throughout the first two years of undergraduate medical education. Here we describe the methods of instruction and integration of gross anatomy and embryology in this curriculum as well as challenges faced along the way. Gross anatomy and embryology are taught through a combination of didactic lectures, team-based learning activities, and cadaveric dissection laboratories. Vertical integration occurs through third- and fourth-year anatomy and embryology elective courses. Radiology is integrated with anatomy instruction through self-study modules and hands-on ultrasound sessions. Our model of anatomy instruction is time efficient, clinically relevant, and effective as demonstrated by student performance on the United States Medical Licensing Examination(®) (USMLE(®) ) Step 1 examination. We recommend that medical schools considering full integration of gross anatomy and embryology (1) carefully consider the sequencing of organ system modules, (2) be willing to sacrifice anatomical detail for clinical application, (3) provide additional electives to third- and fourth-year students, and (4) integrate radiology with anatomical education. © 2014 American Association of Anatomists.

  18. Multi-analytical approach for profiling some essential medical drugs

    International Nuclear Information System (INIS)

    Abubakar, M.

    2015-07-01

    Counterfeit and substandard pharmaceutical drugs are chiefly rampant in developing countries due to inadequate analytical facilities and lack of regulatory oversight. The production of counterfeit or substandard drugs is broadly problematic. Underestimating it therefore leads to morbidity, mortality, drug resistance, introduction of toxic substances into the body and loss of confidence in health care systems. Medical drugs that are often counterfeited range from antimalarial drugs to antiretroviral drugs with antibiotics being counterfeited the most. This research work, therefore, aims at contributing towards the establishment of measures/processes for distinguishing between fake and genuine amoxicillin drugs. This was achieved by the identification and quantification of the Active Pharmaceutical Ingredient (API) and the excipients in the drug formulation. The major analytical techniques employed for this research work were Instrumental Neutron Activation Analysis (INAA), X-ray Powder Diffraction (XRD), High Performance Liquid Chromatography (HPLC) and in vitro Dissolution Test. The amoxicillin samples analyzed were the foreign generic amoxicillin purchased from Ernest Chemists pharmacy at East Legon, Accra, the National Health Insurance Scheme (NHIS) amoxicillin purchased at Fair Mile pharmacy at West Legon, Accra and the Suspected Fake amoxicillin purchased at Okaishi market. For the establishment of fingerprint for identification of substandard amoxicillin, INAA was used to qualitatively determine the short lived radionuclides (excipients) which then facilitated the correct identification of the API and the excipient phases in each of the amoxicillin groups. The phases identified were Amoxicillin Trihydrate as the excipient, Magnesium Stearate (hydrated) and Magnesium Stearate (anhydrous) as the excipients. For Quality control purposes, High Performance Liquid Chromatography approach and also, the in vitro Dissolution test were conducted on each of the groups of

  19. Linking Science and Language Arts: A Review of the Literature Which Compares Integrated versus Non-Integrated Approaches

    Science.gov (United States)

    Bradbury, Leslie U.

    2014-01-01

    The purpose of this paper is to review the literature published during the last 20 years that investigates the impact of approaches that describe themselves as integrating science and language arts on student learning and/or attitude at the elementary level. The majority of papers report that integrated approaches led to greater student…

  20. A web-based knowledge management system integrating Western and Traditional Chinese Medicine for relational medical diagnosis.

    Science.gov (United States)

    Herrera-Hernandez, Maria C; Lai-Yuen, Susana K; Piegl, Les A; Zhang, Xiao

    2016-10-26

    This article presents the design of a web-based knowledge management system as a training and research tool for the exploration of key relationships between Western and Traditional Chinese Medicine, in order to facilitate relational medical diagnosis integrating these mainstream healing modalities. The main goal of this system is to facilitate decision-making processes, while developing skills and creating new medical knowledge. Traditional Chinese Medicine can be considered as an ancient relational knowledge-based approach, focusing on balancing interrelated human functions to reach a healthy state. Western Medicine focuses on specialties and body systems and has achieved advanced methods to evaluate the impact of a health disorder on the body functions. Identifying key relationships between Traditional Chinese and Western Medicine opens new approaches for health care practices and can increase the understanding of human medical conditions. Our knowledge management system was designed from initial datasets of symptoms, known diagnosis and treatments, collected from both medicines. The datasets were subjected to process-oriented analysis, hierarchical knowledge representation and relational database interconnection. Web technology was implemented to develop a user-friendly interface, for easy navigation, training and research. Our system was prototyped with a case study on chronic prostatitis. This trial presented the system's capability for users to learn the correlation approach, connecting knowledge in Western and Traditional Chinese Medicine by querying the database, mapping validated medical information, accessing complementary information from official sites, and creating new knowledge as part of the learning process. By addressing the challenging tasks of data acquisition and modeling, organization, storage and transfer, the proposed web-based knowledge management system is presented as a tool for users in medical training and research to explore, learn and

  1. Systems approaches to integrated solid waste management in developing countries

    International Nuclear Information System (INIS)

    Marshall, Rachael E.; Farahbakhsh, Khosrow

    2013-01-01

    Highlights: ► Five drivers led developed countries to current solid waste management paradigm. ► Many unique factors challenge developing country solid waste management. ► Limited transferability of developed country approaches to developing countries. ► High uncertainties and decision stakes call for post-normal approaches. ► Systems thinking needed for multi-scale, self-organizing eco-social waste systems. - Abstract: Solid waste management (SWM) has become an issue of increasing global concern as urban populations continue to rise and consumption patterns change. The health and environmental implications associated with SWM are mounting in urgency, particularly in the context of developing countries. While systems analyses largely targeting well-defined, engineered systems have been used to help SWM agencies in industrialized countries since the 1960s, collection and removal dominate the SWM sector in developing countries. This review contrasts the history and current paradigms of SWM practices and policies in industrialized countries with the current challenges and complexities faced in developing country SWM. In industrialized countries, public health, environment, resource scarcity, climate change, and public awareness and participation have acted as SWM drivers towards the current paradigm of integrated SWM. However, urbanization, inequality, and economic growth; cultural and socio-economic aspects; policy, governance, and institutional issues; and international influences have complicated SWM in developing countries. This has limited the applicability of approaches that were successful along the SWM development trajectories of industrialized countries. This review demonstrates the importance of founding new SWM approaches for developing country contexts in post-normal science and complex, adaptive systems thinking

  2. Systems approaches to integrated solid waste management in developing countries

    Energy Technology Data Exchange (ETDEWEB)

    Marshall, Rachael E., E-mail: rmarsh01@uoguelph.ca [School of Engineering, University of Guelph, Albert A. Thornbrough Building, Guelph, ON, Canada N1G 2W1 (Canada); Farahbakhsh, Khosrow, E-mail: khosrowf@uoguelph.ca [School of Engineering, University of Guelph, Albert A. Thornbrough Building, Guelph, ON, Canada N1G 2W1 (Canada)

    2013-04-15

    Highlights: ► Five drivers led developed countries to current solid waste management paradigm. ► Many unique factors challenge developing country solid waste management. ► Limited transferability of developed country approaches to developing countries. ► High uncertainties and decision stakes call for post-normal approaches. ► Systems thinking needed for multi-scale, self-organizing eco-social waste systems. - Abstract: Solid waste management (SWM) has become an issue of increasing global concern as urban populations continue to rise and consumption patterns change. The health and environmental implications associated with SWM are mounting in urgency, particularly in the context of developing countries. While systems analyses largely targeting well-defined, engineered systems have been used to help SWM agencies in industrialized countries since the 1960s, collection and removal dominate the SWM sector in developing countries. This review contrasts the history and current paradigms of SWM practices and policies in industrialized countries with the current challenges and complexities faced in developing country SWM. In industrialized countries, public health, environment, resource scarcity, climate change, and public awareness and participation have acted as SWM drivers towards the current paradigm of integrated SWM. However, urbanization, inequality, and economic growth; cultural and socio-economic aspects; policy, governance, and institutional issues; and international influences have complicated SWM in developing countries. This has limited the applicability of approaches that were successful along the SWM development trajectories of industrialized countries. This review demonstrates the importance of founding new SWM approaches for developing country contexts in post-normal science and complex, adaptive systems thinking.

  3. The Site Approach - Lessons Learned from the Integrated Safeguards Approach for JNC-1

    International Nuclear Information System (INIS)

    Kikuchi, M.; Iso, S.; Tomine, K.; Hirato, Y.; Namekawa, M.; Takasugi, N.; Watanabe, M.; Tsutaki, Y.; Asano, T.; Nagatani, T.; Ninagawa, J.; Fujiwara, S.; Takahashi, S.; Kimura, T.; Kodani, Y.; Fukuhara, J.; Miyaji, N.; Kawakami, Y.; Koizumi, A.; Yamazaki, Y.; Nishinosono, S.; Sasaki, K.

    2010-01-01

    Integrated safeguards approaches for specific sites are recognized important elements in the design of a State-level approach under the concept of grouping facilities. Japan and the IAEA agreed further improvement of integrated safeguards implementation in effective and efficient manner, particularly at large complex nuclear sites in Japan. Japan and the IAEA developed the integrated safeguards approach for specific sites defined at Article 18 of Additional Protocol. In 2008, the IAEA started the three-year test implementation of JNC-1 site approach for improving the effectiveness and efficiency of the safeguards implementation of UDU material handling facilities. Japan and IAEA agreed to adopt the sector concept in order to make clear of subjected nuclear material to be verified. The sector is defined as spatial assignment that treats the same material stratum beyond MBAs in the site. The arrangement of MBAs and related material balance calculations as well as statistical analysis is maintained as a fundamental safeguards measure. At the boundaries of each sector, appropriate unattended NDA system and/or C/S system are installed, and material flows across the boundaries are verified by the system or attendance of resident inspectors. For inventory verification of the nuclear material stayed in sectors, an appropriate numbers of randomly scheduled inspections will be implemented. IAEA can access to the randomly selected sectors within 2 hours after notification. NRTA based on frequent operator's declaration will be performed for achievement of timeliness detection goal. The JNC-1 site approach has been implemented under the enhanced co-operation between the IAEA and SSAC through joint use of equipment and arrangements for DA analysis. Especially, national inspectors are working with IAEA together for coordination with operators. Because NMCC lab analyses all DA samples taken from facilities and the analysis results will be shared by the IAEA, certain numbers of DA

  4. First- and Third-person Approaches: the Problem of Integration

    Directory of Open Access Journals (Sweden)

    Olga Markič

    2012-10-01

    Full Text Available The author discusses the problem of integration of first- and third-person approaches in studying the human mind. She critically evaluates and compares various methodologies for studying and explaining conscious experience. Common strategies that apply reductive explanation seem to be unsatisfied for explaining experience and its subjective character. There were attempts to explain experience from the first-person point of view (introspectionism, philosophical phenomenology but the results were not intersubjectively verifiable. Dennett proposed heterophenomenology as a scientifically viable alternative which supposed to bridge the gap between first- and third-person perspectives. The author critically evaluates his proposal and compares it to contemporary attempts to provide first-person methods.

  5. Engineering systems reliability, safety, and maintenance an integrated approach

    CERN Document Server

    Dhillon, B S

    2017-01-01

    Today, engineering systems are an important element of the world economy and each year billions of dollars are spent to develop, manufacture, operate, and maintain various types of engineering systems around the globe. Many of these systems are highly sophisticated and contain millions of parts. For example, a Boeing jumbo 747 is made up of approximately 4.5 million parts including fasteners. Needless to say, reliability, safety, and maintenance of systems such as this have become more important than ever before.  Global competition and other factors are forcing manufacturers to produce highly reliable, safe, and maintainable engineering products. Therefore, there is a definite need for the reliability, safety, and maintenance professionals to work closely during design and other phases. Engineering Systems Reliability, Safety, and Maintenance: An Integrated Approach eliminates the need to consult many different and diverse sources in the hunt for the information required to design better engineering syste...

  6. Path integral approach to electron scattering in classical electromagnetic potential

    International Nuclear Information System (INIS)

    Xu Chuang; Feng Feng; Li Ying-Jun

    2016-01-01

    As is known to all, the electron scattering in classical electromagnetic potential is one of the most widespread applications of quantum theory. Nevertheless, many discussions about electron scattering are based upon single-particle Schrodinger equation or Dirac equation in quantum mechanics rather than the method of quantum field theory. In this paper, by using the path integral approach of quantum field theory, we perturbatively evaluate the scattering amplitude up to the second order for the electron scattering by the classical electromagnetic potential. The results we derive are convenient to apply to all sorts of potential forms. Furthermore, by means of the obtained results, we give explicit calculations for the one-dimensional electric potential. (paper)

  7. Strategic Technology Investment Analysis: An Integrated System Approach

    Science.gov (United States)

    Adumitroaie, V.; Weisbin, C. R.

    2010-01-01

    Complex technology investment decisions within NASA are increasingly difficult to make such that the end results are satisfying the technical objectives and all the organizational constraints. Due to a restricted science budget environment and numerous required technology developments, the investment decisions need to take into account not only the functional impact on the program goals, but also development uncertainties and cost variations along with maintaining a healthy workforce. This paper describes an approach for optimizing and qualifying technology investment portfolios from the perspective of an integrated system model. The methodology encompasses multi-attribute decision theory elements and sensitivity analysis. The evaluation of the degree of robustness of the recommended portfolio provides the decision-maker with an array of viable selection alternatives, which take into account input uncertainties and possibly satisfy nontechnical constraints. The methodology is presented in the context of assessing capability development portfolios for NASA technology programs.

  8. Modeling fabrication of nuclear components: An integrative approach

    Energy Technology Data Exchange (ETDEWEB)

    Hench, K.W.

    1996-08-01

    Reduction of the nuclear weapons stockpile and the general downsizing of the nuclear weapons complex has presented challenges for Los Alamos. One is to design an optimized fabrication facility to manufacture nuclear weapon primary components in an environment of intense regulation and shrinking budgets. This dissertation presents an integrative two-stage approach to modeling the casting operation for fabrication of nuclear weapon primary components. The first stage optimizes personnel radiation exposure for the casting operation layout by modeling the operation as a facility layout problem formulated as a quadratic assignment problem. The solution procedure uses an evolutionary heuristic technique. The best solutions to the layout problem are used as input to the second stage - a simulation model that assesses the impact of competing layouts on operational performance. The focus of the simulation model is to determine the layout that minimizes personnel radiation exposures and nuclear material movement, and maximizes the utilization of capacity for finished units.

  9. CLARM: An integrative approach for functional modules discovery

    KAUST Repository

    Salem, Saeed M.

    2011-01-01

    Functional module discovery aims to find well-connected subnetworks which can serve as candidate protein complexes. Advances in High-throughput proteomic technologies have enabled the collection of large amount of interaction data as well as gene expression data. We propose, CLARM, a clustering algorithm that integrates gene expression profiles and protein protein interaction network for biological modules discovery. The main premise is that by enriching the interaction network by adding interactions between genes which are highly co-expressed over a wide range of biological and environmental conditions, we can improve the quality of the discovered modules. Protein protein interactions, known protein complexes, and gene expression profiles for diverse environmental conditions from the yeast Saccharomyces cerevisiae were used for evaluate the biological significance of the reported modules. Our experiments show that the CLARM approach is competitive to wellestablished module discovery methods. Copyright © 2011 ACM.

  10. NRC says integrated approach needed to understand, protect environment

    Science.gov (United States)

    Kolb, Charles E.; Loehr, Raymond C.; Gopnik, Morgan

    A recent study by the National Research Council (NRC) advocates a more comprehensive and integrated approach to our nation's environmental research and development (R&D) activities. Because we face environmental problems of unprecedented complexity, the study maintains that the traditional practice of studying isolated environmental problems and devising narrowly focused control or remediation strategies to manage them will no longer suffice.In the report, Building a Foundation for Sound Environmental Decisions [National Academy Press, 1997], an NRC committee highlighted the need for developing a deeper scientific understanding of ecosystems, as well as the sociological and economic aspects of human interactions with the environment. To achieve these goals, the committee recommended a core research agenda for the Environmental Protection Agency (EPA) that has three components.

  11. An integrated MCDM approach to green supplier selection

    Directory of Open Access Journals (Sweden)

    Morteza Yazdani

    2014-06-01

    Full Text Available Supplier selection management has been considered as an important subject for industrial organizations. In order to remain on the market, to gain profitability and to retain competitive advantage, business units need to establish an integrated and structured supplier selection system. In addition, environmental protection problems have been big solicitudes for organizations to consider green approach in supplier selection problem. However, finding proper suppliers involves several variables and it is critically a complex process. In this paper, the main attention is focused on finding the right supplier based on fuzzy multi criteria decision making (MCDM process. The weights of criteria are calculated by analytical hierarchical process (AHP and the final ranking is achieved by fuzzy technique for order preference by similarity to an ideal solution (TOPSIS. TOPSIS advantage among the other similar methods is to obtain the best solution close to ideal solution. The paper attempts to express better understanding by an example of an automobile manufacturing supply chain.

  12. Science based integrated approach to advanced nuclear fuel development - vision, approach, and overview

    Energy Technology Data Exchange (ETDEWEB)

    Unal, Cetin [Los Alamos National Laboratory; Pasamehmetoglu, Kemal [IDAHO NATIONAL LAB; Carmack, Jon [IDAHO NATIONAL LAB

    2010-01-01

    Advancing the performance of Light Water Reactors, Advanced Nuclear Fuel Cycles, and Advanced Rcactors, such as the Next Generation Nuclear Power Plants, requires enhancing our fundamental understanding of fuel and materials behavior under irradiation. The capability to accurately model the nuclear fuel systems is critical. In order to understand specific aspects of the nuclear fuel, fully coupled fuel simulation codes are required to achieve licensing of specific nuclear fuel designs for operation. The backbone of these codes, models, and simulations is a fundamental understanding and predictive capability for simulating the phase and microstructural behavior of the nuclear fuel system materials and matrices. The purpose of this paper is to identify the modeling and simulation approach in order to deliver predictive tools for advanced fuels development. The coordination between experimental nuclear fuel design, development technical experts, and computational fuel modeling and simulation technical experts is a critical aspect of the approach and naturally leads to an integrated, goal-oriented science-based R & D approach and strengthens both the experimental and computational efforts. The Advanced Fuels Campaign (AFC) and Nuclear Energy Advanced Modeling and Simulation (NEAMS) Fuels Integrated Performance and Safety Code (IPSC) are working together to determine experimental data and modeling needs. The primary objective of the NEAMS fuels IPSC project is to deliver a coupled, three-dimensional, predictive computational platform for modeling the fabrication and both normal and abnormal operation of nuclear fuel pins and assemblies, applicable to both existing and future reactor fuel designs. The science based program is pursuing the development of an integrated multi-scale and multi-physics modeling and simulation platform for nuclear fuels. This overview paper discusses the vision, goals and approaches how to develop and implement the new approach.

  13. Clinical capabilities of graduates of an outcomes-based integrated medical program

    Directory of Open Access Journals (Sweden)

    Scicluna Helen A

    2012-06-01

    Full Text Available Abstract Background The University of New South Wales (UNSW Faculty of Medicine replaced its old content-based curriculum with an innovative new 6-year undergraduate entry outcomes-based integrated program in 2004. This paper is an initial evaluation of the perceived and assessed clinical capabilities of recent graduates of the new outcomes-based integrated medical program compared to benchmarks from traditional content-based or process-based programs. Method Self-perceived capability in a range of clinical tasks and assessment of medical education as preparation for hospital practice were evaluated in recent graduates after 3 months working as junior doctors. Responses of the 2009 graduates of the UNSW’s new outcomes-based integrated medical education program were compared to those of the 2007 graduates of UNSW’s previous content-based program, to published data from other Australian medical schools, and to hospital-based supervisor evaluations of their clinical competence. Results Three months into internship, graduates from UNSW’s new outcomes-based integrated program rated themselves to have good clinical and procedural skills, with ratings that indicated significantly greater capability than graduates of the previous UNSW content-based program. New program graduates rated themselves significantly more prepared for hospital practice in the confidence (reflective practice, prevention (social aspects of health, interpersonal skills (communication, and collaboration (teamwork subscales than old program students, and significantly better or equivalent to published benchmarks of graduates from other Australian medical schools. Clinical supervisors rated new program graduates highly capable for teamwork, reflective practice and communication. Conclusions Medical students from an outcomes-based integrated program graduate with excellent self-rated and supervisor-evaluated capabilities in a range of clinically-relevant outcomes. The program

  14. A novel virtual hub approach for multisource downstream service integration

    Science.gov (United States)

    Previtali, Mattia; Cuca, Branka; Barazzetti, Luigi

    2016-08-01

    A large development of downstream services is expected to be stimulated starting from earth observations (EO) datasets acquired by Copernicus satellites. An important challenge connected with the availability of downstream services is the possibility for their integration in order to create innovative applications with added values for users of different categories level. At the moment, the world of geo-information (GI) is extremely heterogeneous in terms of standards and formats used, thus preventing a facilitated access and integration of downstream services. Indeed, different users and data providers have also different requirements in terms of communication protocols and technology advancement. In recent years, many important programs and initiatives have tried to address this issue even on trans-regional and international level (e.g. INSPIRE Directive, GEOSS, Eye on Earth and SEIS). However, a lack of interoperability between systems and services still exists. In order to facilitate the interaction between different downstream services, a new architectural approach (developed within the European project ENERGIC OD) is proposed in this paper. The brokering-oriented architecture introduces a new mediation layer (the Virtual Hub) which works as an intermediary to bridge the gaps linked to interoperability issues. This intermediation layer de-couples the server and the client allowing a facilitated access to multiple downstream services and also Open Data provided by national and local SDIs. In particular, in this paper an application is presented integrating four services on the topic of agriculture: (i) the service given by Space4Agri (providing services based on MODIS and Landsat data); (ii) Gicarus Lab (providing sample services based on Landsat datasets) and (iii) FRESHMON (providing sample services for water quality) and services from a several regional SDIs.

  15. An integrated approach of composting methodologies for solid waste management

    Directory of Open Access Journals (Sweden)

    K. Kumaresan

    2016-03-01

    Full Text Available Organic fraction of solid waste, which upon degradation produces foul smell and generates pathogens, if not properly managed. Composting is not a method of waste disposal but it is a method of waste recycling and used for agricultural purposes. An integrated approach of composting methodology was tested for municipal solid waste management. Solid waste first was composted and after 22 days, was further processed by vermicomposting. Samples were routinely taken for analysis of carbon, nitrogen, moisture content, pH and temperature to determine the quality of composting. Decrease in moisture content to 32.1 %, relative decrease in carbon and nitrogen content were also observed. Among the different types of treatment, municipal solid waste + activated sludge integration showed promising results, followed by vermicomposting municipal solid waste + activated sludge combination, compared to the combinations of dried activated sludge, municipal solid waste + activated sludge semisolid and municipal solid waste + sewage water. Thus, windrow composting followed by vermicomposting gave a better result than other methods. Thus this method would serve as a potential alternative for solid waste management.

  16. An integrated approach of composting methodologies for solid waste management

    International Nuclear Information System (INIS)

    Kumaresan, K.; Balan, R.; Sridhar, A.; Aravind, J.; Kanmani, P.

    2016-01-01

    Organic fraction of solid waste, which upon degradation produces foul smell and generates pathogens, if not properly managed. Composting is not a method of waste disposal but it is a method of waste recycling and used for agricultural purposes. An integrated approach of composting methodology was tested for municipal solid waste management. Solid waste first was composted and after 22 days, was further processed by vermicomposting. Samples were routinely taken for analysis of carbon, nitrogen, moisture content, p H and temperature to determine the quality of composting. Decrease in moisture content to 32.1 %, relative decrease in carbon and nitrogen content were also observed. Among the different types of treatment, municipal solid waste + activated sludge integration showed promising results, followed by vermicomposting municipal solid waste + activated sludge combination, compared to the combinations of dried activated sludge, municipal solid waste + activated sludge semisolid and municipal solid waste + sewage water. Thus, windrow composting followed by vermicomposting gave a better result than other methods. Thus this method would serve as a potential alternative for solid waste management.

  17. [Rehabilitation management categories. A new approach to case mix in medical rehabilitation].

    Science.gov (United States)

    Spyra, K; Müller-Fahrnow, W

    1998-06-01

    Creating typical treatment case groups in medical rehabilitation, in short: Rehabilitee Management Categories (RMKs, Rehabilitanden-Management-Kategorien), is a key issue for quality assurance within the frame of modern concepts of Total Quality Management (TQM), not least utilizing current organization and management concepts (Managed Care). So far, the problem of creating highly homogeneous case groups has remained unsolved on the basis of the present methodological framework. Critical prerequisites for any further scientific work on this problem are being established in the field of medical rehabilitation with the help of the Classification of Therapeutic Services (CTS) as well as development of instruments documenting therapy plans for typical rehabilitation case groups, process-relevant quality features and definitions of therapy goals as a basis for quality screening under the Pension Insurance quality assurance programme in medical rehabilitation. These developments have clearly contributed to expanding the theoretical foundations as well as the prerequisites for empirical grounding of Rehabilitee Management Categories in medical rehabilitation under the Pension Insurance scheme. A project for determination of rehabilitation case groups which is based on these developments, is due to start at the Humboldt University and Technical University, Berlin in the near future within a rehab promotion initiative of the German Pension Insurance system in cooperation with the Federal Ministry of Research and Technology. Conceptually, the determination of Rehabilitee Management Categories by far exceeds all previous approaches as (1) it will be generated by an iterative process of empirical service descriptions and theoretical consensus building among experts, (2) not only static parameters but also process-related details will be recorded, and (3) quality requirements will be defined for the rehabilitation process and outcome. As a result, rehabilitation-relevant case

  18. An Approach to Establishing International Quality Standards for Medical Travel

    Directory of Open Access Journals (Sweden)

    Ondřej eKácha

    2016-03-01

    Full Text Available Traveling abroad to receive a non-elective treatment is expanding each year. Such rising popularity of medical travel and the absence of clear minimum quality requirements in this area urgently calls for setting international standards to ensure good practice and patient safety. The aim of this study is to identify the key domains in medical travel where such quality standards should be established. Drawing from the evidence-based OECD framework and an extensive literature review, this study proposes three critical areas for international quality standards in medical travel: minimum standards of health care facilities and third-party agencies, financial responsibility and patient-centeredness. Several cultural challenges are subsequently introduced that may pose a barrier to the development of the guidelines and should be additionally taken into consideration. Establishing international quality standards in medical travel enhances the benefits to patients and providers, which is urgently needed given the rapid growth in this industry.

  19. Hedging Medical Spending Growth: An Adaptive Expectations Approach

    Science.gov (United States)

    Lieberthal, Robert D.

    2016-01-01

    Long-term health insurance provides consumers with protection against persistent, negative health shocks. While the stochastic rise in medical spending growth may make some health risks harder to insure, financial assets could act as a hedge for medical spending growth risk. The purpose of this research was to determine whether such hedges exist. The results of this study were two-fold. First, the asset classes with the strongest statistical evidence as hedges were bonds, not stocks. Second, any strategy to hedge medical spending growth involved shorting assets i.e. betting against the bond or stock market. Health insurers writing long-term contracts should combine the use of hedges in the bond market with of portfolio diversification, and may benefit from health policies to moderate the uncertainty of medical spending growth. PMID:27635415

  20. A learning collaborative of CMHCs and CHCs to support integration of behavioral health and general medical care.

    Science.gov (United States)

    Vannoy, Steven D; Mauer, Barbara; Kern, John; Girn, Kamaljeet; Ingoglia, Charles; Campbell, Jeannie; Galbreath, Laura; Unützer, Jürgen

    2011-07-01

    Integration of general medical and mental health services is a growing priority for safety-net providers. The authors describe a project that established a one-year learning collaborative focused on integration of services between community health centers (CHCs) and community mental health centers (CMHCs). Specific targets were treatment for general medical and psychiatric symptoms related to depression, bipolar disorder, alcohol use disorders, and metabolic syndrome. This observational study used mixed methods. Quantitative measures included 15 patient-level health indicators, practice self-assessment of resources and support for chronic disease self-management, and participant satisfaction. Sixteen CHC-CMHC pairs were selected for the learning collaborative series. One pair dropped out because of personnel turnover. All teams increased capacity on one or more patient health indicators. CHCs scored higher than CMHCs on support for chronic disease self-management. Participation in the learning collaborative increased self-assessment scores for CHCs and CMHCs. Participant satisfaction was high. Observations by faculty indicate that quality improvement challenges included tracking patient-level outcomes, workforce issues, and cross-agency communication. Even though numerous systemic barriers were encountered, the findings support existing literature indicating that the learning collaborative is a viable quality improvement approach for enhancing integration of general medical and mental health services between CHCs and CMHCs. Real-world implementation of evidence-based guidelines presents challenges often absent in research. Technical resources and support, a stable workforce with adequate training, and adequate opportunities for collaborator communications are particular challenges for integrating behavioral and general medical services across CHCs and CMHCs.

  1. MIRACLE’s Naive Approach to Medical Images Annotation

    OpenAIRE

    Villena Román, Julio; González Cristóbal, José Carlos; Goñi Menoyo, José Miguel; Martínez Fernández, José Luis

    2005-01-01

    One of the proposed tasks of the ImageCLEF 2005 campaign has been an Automatic Annotation Task. The objective is to provide the classification of a given set of 1,000 previously unseen medical (radiological) images according to 57 predefined categories covering different medical pathologies. 9,000 classified training images are given which can be used in any way to train a classifier. The Automatic Annotation task uses no textual information, but image-content information only. This paper des...

  2. A structured approach to medical comanagement of surgical patients

    OpenAIRE

    Eric Siegal

    2012-01-01

    Comanagement is defined as shared responsibility, authority and accountability for the management of a hospitalized patient, and represents a fundamentally different model from traditional medical consultation. Medical comanagement has rapidly proliferated and is now a dominant model of care in American hospitals. Comanagement is most effective when patients are appropriately selected, processes are predetermined and systems are implemented to ensure rigorous and continuous improvement. This ...

  3. Holistic Approach for Teaching Tuberculosis in Medical Education

    Directory of Open Access Journals (Sweden)

    Saurabh RamBihariLal Shrivastava

    2014-05-01

    Full Text Available Tuberculosis (TB is the foremost cause of mortality attributed to a curable infectious disease globally, accounting for 8.6 million new cases in the year 2012, of which India alone has a share of almost 25% of cases. Medical colleges have been acknowledged as tertiary level health care centers and have a key role in the diagnosis and management of different types of TB cases. However, a wide range of barriers and deficiencies have been acknowledged in the medical education curriculum over a period of time with regard to teaching of TB control. To combat the magnitude of TB on the health sector in Indian set-up, there is a crucial need for establishing a mutual and complementary partnership between policy makers, delegates from the medical colleges, and the regulatory body for medical education. In summary, medical students are the future health care providers for the general population and thus a well-organized medical education curriculum can play a significant role in reducing the magnitude of tuberculosis in the coming decade.

  4. Implementation of a cloud-based electronic medical record exchange system in compliance with the integrating healthcare enterprise's cross-enterprise document sharing integration profile.

    Science.gov (United States)

    Wu, Chien Hua; Chiu, Ruey Kei; Yeh, Hong Mo; Wang, Da Wei

    2017-11-01

    In 2011, the Ministry of Health and Welfare of Taiwan established the National Electronic Medical Record Exchange Center (EEC) to permit the sharing of medical resources among hospitals. This system can presently exchange electronic medical records (EMRs) among hospitals, in the form of medical imaging reports, laboratory test reports, discharge summaries, outpatient records, and outpatient medication records. Hospitals can send or retrieve EMRs over the virtual private network by connecting to the EEC through a gateway. International standards should be adopted in the EEC to allow users with those standards to take advantage of this exchange service. In this study, a cloud-based EMR-exchange prototyping system was implemented on the basis of the Integrating the Healthcare Enterprise's Cross-Enterprise Document Sharing integration profile and the existing EMR exchange system. RESTful services were used to implement the proposed prototyping system on the Microsoft Azure cloud-computing platform. Four scenarios were created in Microsoft Azure to determine the feasibility and effectiveness of the proposed system. The experimental results demonstrated that the proposed system successfully completed EMR exchange under the four scenarios created in Microsoft Azure. Additional experiments were conducted to compare the efficiency of the EMR-exchanging mechanisms of the proposed system with those of the existing EEC system. The experimental results suggest that the proposed RESTful service approach is superior to the Simple Object Access Protocol method currently implemented in the EEC system, according to the irrespective response times under the four experimental scenarios. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Project INTEGRATE - a common methodological approach to understand integrated health care in Europe

    Directory of Open Access Journals (Sweden)

    Lucinda Cash-Gibson

    2014-12-01

    Full Text Available Background: The use of case studies in health services research has proven to be an excellent methodology for gaining in-depth understanding of the organisation and delivery of health care. This is particularly relevant when looking at the complexity of integrated healthcare programmes, where multifaceted interactions occur at the different levels of care and often without a clear link between the interventions (new and/or existing and their impact on outcomes (in terms of patients health, both patient and professional satisfaction and cost-effectiveness. Still, integrated care is seen as a core strategy in the sustainability of health and care provision in most societies in Europe and beyond. More specifically, at present, there is neither clear evidence on transferable factors of integrated care success nor a method for determining how to establish these specific success factors. The drawback of case methodology in this case, however, is that the in-depth results or lessons generated are usually highly context-specific and thus brings the challenge of transferability of findings to other settings, as different health care systems and different indications are often not comparable. Project INTEGRATE, a European Commission-funded project, has been designed to overcome these problems; it looks into four chronic conditions in different European settings, under a common methodology framework (taking a mixed-methods approach to try to overcome the issue of context specificity and limited transferability. The common methodological framework described in this paper seeks to bring together the different case study findings in a way that key lessons may be derived and transferred between countries, contexts and patient-groups, where integrated care is delivered in order to provide insight into generalisability and build on existing evidence in this field.Methodology: To compare the different integrated care experiences, a mixed-methods approach has

  6. An integrated approach for facilities planning by ELECTRE method

    Science.gov (United States)

    Elbishari, E. M. Y.; Hazza, M. H. F. Al; Adesta, E. Y. T.; Rahman, Nur Salihah Binti Abdul

    2018-01-01

    Facility planning is concerned with the design, layout, and accommodation of people, machines and activities of a system. Most of the researchers try to investigate the production area layout and the related facilities. However, few of them try to investigate the relationship between the production space and its relationship with service departments. The aim of this research to is to integrate different approaches in order to evaluate, analyse and select the best facilities planning method that able to explain the relationship between the production area and other supporting departments and its effect on human efforts. To achieve the objective of this research two different approaches have been integrated: Apple’s layout procedure as one of the effective tools in planning factories, ELECTRE method as one of the Multi Criteria Decision Making methods (MCDM) to minimize the risk of getting poor facilities planning. Dalia industries have been selected as a case study to implement our integration the factory have been divided two main different area: the whole facility (layout A), and the manufacturing area (layout B). This article will be concerned with the manufacturing area layout (Layout B). After analysing the data gathered, the manufacturing area was divided into 10 activities. There are five factors that the alternative were compared upon which are: Inter department satisfactory level, total distance travelled for workers, total distance travelled for the product, total time travelled for the workers, and total time travelled for the product. Three different layout alternatives have been developed in addition to the original layouts. Apple’s layout procedure was used to study and evaluate the different alternatives layouts, the study and evaluation of the layouts was done by calculating scores for each of the factors. After obtaining the scores from evaluating the layouts, ELECTRE method was used to compare the proposed alternatives with each other and with

  7. Integrated Medical Model (IMM) Project Verification, Validation, and Credibility (VVandC)

    Science.gov (United States)

    Walton, M.; Boley, L.; Keenan, L.; Kerstman, E.; Shah, R.; Young, M.; Saile, L.; Garcia, Y.; Meyers, J.; Reyes, D.

    2015-01-01

    The Integrated Medical Model (IMM) Project supports end user requests by employing the Integrated Medical Evidence Database (iMED) and IMM tools as well as subject matter expertise within the Project. The iMED houses data used by the IMM. The IMM is designed to forecast relative changes for a specified set of crew health and mission success risk metrics by using a probabilistic model based on historical data, cohort data, and subject matter expert opinion. A stochastic approach is taken because deterministic results would not appropriately reflect the uncertainty in the IMM inputs. Once the IMM was conceptualized, a plan was needed to rigorously assess input information, framework and code, and output results of the IMM, and ensure that end user requests and requirements were considered during all stages of model development and implementation, as well as lay the foundation for external review and application. METHODS: In 2008, the Project team developed a comprehensive verification and validation (VV) plan, which specified internal and external review criteria encompassing 1) verification of data and IMM structure to ensure proper implementation of the IMM, 2) several validation techniques to confirm that the simulation capability of the IMM appropriately represents occurrences and consequences of medical conditions during space missions, and 3) credibility processes to develop user confidence in the information derived from the IMM. When the NASA-STD-7009 (7009) [1] was published, the Project team updated their verification, validation, and credibility (VVC) project plan to meet 7009 requirements and include 7009 tools in reporting VVC status of the IMM. Construction of these tools included meeting documentation and evidence requirements sufficient to meet external review success criteria. RESULTS: IMM Project VVC updates are compiled recurrently and include updates to the 7009 Compliance and Credibility matrices. Reporting tools have evolved over the lifetime of

  8. Phytoremediation of coal mine spoil dump through integrated biotechnological approach

    Energy Technology Data Exchange (ETDEWEB)

    Juwarkar, A.A.; Jambhulkar, H.P. [National Environmental Engineering Research Institute, Nagpur (India)

    2008-07-15

    Field experiment was conducted on mine spoil dump on an area of 10 ha, to restore the fertility and productivity of the coal mine spoil dump using integrated biotechnological approach. The approach involves use of effluent treatment plant sludge (ETP sludge), as an organic amendment, biofertilizers and mycorrihzal fungi along with suitable plant species. The results of the study indicated that amendment with effluent treatment plant sludge (ETP sludge), at 50 ton/ha improved the physico-chemical properties of coal mine spoil. Due to biofertilizer inoculation different microbial groups such as Rhizobium, Azotobacter and VAM spores, which were practically absent in mine spoil improved greatly. Inoculation of biofertilizer and application of ETP sludge helped in reducing the toxicity of heavy metals such as chromium, zinc, copper, iron, manganese lead, nickel and cadmium, which were significantly reduced to 41%, 43%, 37%, 37%, 34%, 39%, 37% and 40%, respectively, due to the increased organic matter content in the ETP sludge and its alkaline pH (8.10-8.28), at which the metals gets immobilized and translocation of metals is arrested. Thus, amendment and biofertilizer application provided better supportive material for anchorage and growth of the plant on coal mine spoil dump.

  9. Social Network Analyses and Nutritional Behavior: An Integrated Modeling Approach

    Directory of Open Access Journals (Sweden)

    Alistair McNair Senior

    2016-01-01

    Full Text Available Animals have evolved complex foraging strategies to obtain a nutritionally balanced diet and associated fitness benefits. Recent advances in nutrition research, combining state-space models of nutritional geometry with agent-based models of systems biology, show how nutrient targeted foraging behavior can also influence animal social interactions, ultimately affecting collective dynamics and group structures. Here we demonstrate how social network analyses can be integrated into such a modeling framework and provide a tangible and practical analytical tool to compare experimental results with theory. We illustrate our approach by examining the case of nutritionally mediated dominance hierarchies. First we show how nutritionally explicit agent-based models that simulate the emergence of dominance hierarchies can be used to generate social networks. Importantly the structural properties of our simulated networks bear similarities to dominance networks of real animals (where conflicts are not always directly related to nutrition. Finally, we demonstrate how metrics from social network analyses can be used to predict the fitness of agents in these simulated competitive environments. Our results highlight the potential importance of nutritional mechanisms in shaping dominance interactions in a wide range of social and ecological contexts. Nutrition likely influences social interaction in many species, and yet a theoretical framework for exploring these effects is currently lacking. Combining social network analyses with computational models from nutritional ecology may bridge this divide, representing a pragmatic approach for generating theoretical predictions for nutritional experiments.

  10. Social Network Analysis and Nutritional Behavior: An Integrated Modeling Approach.

    Science.gov (United States)

    Senior, Alistair M; Lihoreau, Mathieu; Buhl, Jerome; Raubenheimer, David; Simpson, Stephen J

    2016-01-01

    Animals have evolved complex foraging strategies to obtain a nutritionally balanced diet and associated fitness benefits. Recent research combining state-space models of nutritional geometry with agent-based models (ABMs), show how nutrient targeted foraging behavior can also influence animal social interactions, ultimately affecting collective dynamics and group structures. Here we demonstrate how social network analyses can be integrated into such a modeling framework and provide a practical analytical tool to compare experimental results with theory. We illustrate our approach by examining the case of nutritionally mediated dominance hierarchies. First we show how nutritionally explicit ABMs that simulate the emergence of dominance hierarchies can be used to generate social networks. Importantly the structural properties of our simulated networks bear similarities to dominance networks of real animals (where conflicts are not always directly related to nutrition). Finally, we demonstrate how metrics from social network analyses can be used to predict the fitness of agents in these simulated competitive environments. Our results highlight the potential importance of nutritional mechanisms in shaping dominance interactions in a wide range of social and ecological contexts. Nutrition likely influences social interactions in many species, and yet a theoretical framework for exploring these effects is currently lacking. Combining social network analyses with computational models from nutritional ecology may bridge this divide, representing a pragmatic approach for generating theoretical predictions for nutritional experiments.

  11. Systems approaches to integrated solid waste management in developing countries.

    Science.gov (United States)

    Marshall, Rachael E; Farahbakhsh, Khosrow

    2013-04-01

    Solid waste management (SWM) has become an issue of increasing global concern as urban populations continue to rise and consumption patterns change. The health and environmental implications associated with SWM are mounting in urgency, particularly in the context of developing countries. While systems analyses largely targeting well-defined, engineered systems have been used to help SWM agencies in industrialized countries since the 1960s, collection and removal dominate the SWM sector in developing countries. This review contrasts the history and current paradigms of SWM practices and policies in industrialized countries with the current challenges and complexities faced in developing country SWM. In industrialized countries, public health, environment, resource scarcity, climate change, and public awareness and participation have acted as SWM drivers towards the current paradigm of integrated SWM. However, urbanization, inequality, and economic growth; cultural and socio-economic aspects; policy, governance, and institutional issues; and international influences have complicated SWM in developing countries. This has limited the applicability of approaches that were successful along the SWM development trajectories of industrialized countries. This review demonstrates the importance of founding new SWM approaches for developing country contexts in post-normal science and complex, adaptive systems thinking. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Data integration, systems approach and multilevel description of complex biosystems

    Science.gov (United States)

    Hernández-Lemus, Enrique

    2013-12-01

    Recent years have witnessed the development of new quantitative approaches and theoretical tenets in the biological sciences. The advent of high throughput experiments in genomics, proteomics and electrophysiology (to cite just a few examples) have provided the researchers with unprecedented amounts of data to be analyzed. Large datasets, however can not provide the means to achieve a complete understanding of the underlying biological phenomena, unless they are supplied with a solid theoretical framework and with proper analytical tools. It is now widely accepted that by using and extending some of the paradigmatic principles of what has been called complex systems theory, some degree of advance in this direction can be attained. We will be presenting ways in which by using data integration techniques (linear, non-linear, combinatorial, graphical), multidimensional-multilevel descriptions (multifractal modeling, dimensionality reduction, computational learning), as well as an approach based in systems theory (interaction maps, probabilistic graphical models, non-equilibrium physics) have allowed us to better understand some problems in the interface of Statistical Physics and Computational Biology.

  13. Integration of measurement data in the comprehensive modelling approach

    Science.gov (United States)

    Sieber, I.; Rübenach, O.

    2013-09-01

    Efficient and reliable optical design requires knowledge of the production chain, the materials used, and the environmental circumstances in the field of operation. This is realized in the comprehensive modelling approach consisting of three steps: • Design for manufacturing, i.e. the model must be adjusted to the process chain. Knowledge of design rules is required. • Robust design, i.e. optimization of the functional design with the objective of a compensation of the tolerance influences on the system's performance. Knowledge of the tolerances of the individual process steps is required. • Reliable design with respect to environmental and operational effects, respectively. Coupling of an optical and mechanical simulation tool is required to form the optical simulation environment. The availability of process knowledge such as e.g. design rules and manufacturing tolerances is ensured by coupling of the optical simulation environment with a process knowledge database. Integration of measured surface data in this simulation environment enables a realistic simulation and analysis of real, manufactured optics. This approach allows e.g. for the evaluation of replication methods such as precision molding or injection molding against high-precision manufacturing methods, e.g. diamond turning.

  14. Integrated approach for coastal hazards and risks in Sri Lanka

    Directory of Open Access Journals (Sweden)

    M. Garcin

    2008-06-01

    Full Text Available The devastating impact of the tsunami of 26 December 2004 on the shores of the Indian Ocean recalled the importance of knowledge and the taking into account of coastal hazards. Sri Lanka was one of the countries most affected by this tsunami (e.g. 30 000 dead, 1 million people homeless and 70% of the fishing fleet destroyed. Following this tsunami, as part of the French post-tsunami aid, a project to establish a Geographical Information System (GIS on coastal hazards and risks was funded. This project aims to define, at a pilot site, a methodology for multiple coastal hazards assessment that might be useful for the post-tsunami reconstruction and for development planning. This methodology could be applied to the whole coastline of Sri Lanka.

    The multi-hazard approach deals with very different coastal processes in terms of dynamics as well as in terms of return period. The first elements of this study are presented here. We used a set of tools integrating a GIS, numerical simulations and risk scenario modelling. While this action occurred in response to the crisis caused by the tsunami, it was decided to integrate other coastal hazards into the study. Although less dramatic than the tsunami these remain responsible for loss of life and damage. Furthermore, the establishment of such a system could not ignore the longer-term effects of climate change on coastal hazards in Sri Lanka.

    This GIS integrates the physical and demographic data available in Sri Lanka that is useful for assessing the coastal hazards and risks. In addition, these data have been used in numerical modelling of the waves generated during periods of monsoon as well as for the December 2004 tsunami. Risk scenarios have also been assessed for test areas and validated by field data acquired during the project. The results obtained from the models can be further integrated into the GIS and contribute to its enrichment and to help in better assessment and mitigation

  15. Criminal Rehabilitation Through Medical Intervention: Moral Liability and the Right to Bodily Integrity.

    Science.gov (United States)

    Douglas, Thomas

    2014-06-01

    Criminal offenders are sometimes required, by the institutions of criminal justice, to undergo medical interventions intended to promote rehabilitation. Ethical debate regarding this practice has largely proceeded on the assumption that medical interventions may only permissibly be administered to criminal offenders with their consent. In this article I challenge this assumption by suggesting that committing a crime might render one morally liable to certain forms of medical intervention. I then consider whether it is possible to respond persuasively to this challenge by invoking the right to bodily integrity. I argue that it is not.

  16. Identifying medication error chains from critical incident reports: a new analytic approach.

    Science.gov (United States)

    Huckels-Baumgart, Saskia; Manser, Tanja

    2014-10-01

    Research into the distribution of medication errors usually focuses on isolated stages within the medication use process. Our study aimed to provide a novel process-oriented approach to medication incident analysis focusing on medication error chains. Our study was conducted across a 900-bed teaching hospital in Switzerland. All reported 1,591 medication errors 2009-2012 were categorized using the Medication Error Index NCC MERP and the WHO Classification for Patient Safety Methodology. In order to identify medication error chains, each reported medication incident was allocated to the relevant stage of the hospital medication use process. Only 25.8% of the reported medication errors were detected before they propagated through the medication use process. The majority of medication errors (74.2%) formed an error chain encompassing two or more stages. The most frequent error chain comprised preparation up to and including medication administration (45.2%). "Non-consideration of documentation/prescribing" during the drug preparation was the most frequent contributor for "wrong dose" during the administration of medication. Medication error chains provide important insights for detecting and stopping medication errors before they reach the patient. Existing and new safety barriers need to be extended to interrupt error chains and to improve patient safety. © 2014, The American College of Clinical Pharmacology.

  17. Introducing integrated teaching and comparison with traditional teaching in undergraduate medical curriculum: A pilot study

    Directory of Open Access Journals (Sweden)

    Mausumi Basu

    2015-01-01

    Full Text Available Background: Medical colleges in India usually follow a traditional curriculum, characterized by "discipline wise model" which compelled Medical Council of India to recommend a teaching approach characterized by maximal efforts to encourage integrated teaching (IT between traditional subject areas. Objectives: To assess the feasibility of IT; to compare IT with traditional teaching (TT and to analyze the student′s feedback and faculty feedback about perception of IT. Materials and Methods: An interventional study was conducted among fifth semester students using pre- and post-test questionnaire and student and faculty feedback forms. Students were divided randomly into two groups. IT was introduced to Group I on the topic of tuberculosis (TB by faculties of different disciplines; using methods of didactic lectures, seminars, role play, clinical case presentation, demonstration of Ziehl-Neelsen stain, Bacillus Calmette-Guerin vaccination and visit to Directly Observed Treatment Centre. Group II were exposed to TT on TB by faculties of Community Medicine using method of didactic lectures. Paired and un-paired t-test and effect size were used as statistical tests. Results : Statistically significant results were obtained using pre- and post-test questionnaire of IT. Similarly, statistically significant results were obtained using posttest results of IT and TT. Effect size that is: Cohen′s d and Pearson correlation revealed large effect which indicates high influence on student achievement. The students and faculty showed a positive attitude about IT. Conclusion: The introduction of IT was found to be feasible and to be more effective and acceptable than TT.

  18. Integrating Quality Improvement and Continuing Professional Development at an Academic Medical Center: A Partnership Between Practice Plan, Hospital, and Medical School.

    Science.gov (United States)

    Gold, Barbara; England, Dawn; Riley, William; Jacobs-Halsey, Ginny; Webb, Corinne; Daniels, Bobbi

    2016-01-01

    While quality improvement (QI) initiatives can be a highly effective means for improving health care delivery in academic medical centers (AMCs), many health care professionals are not formally trained in basic QI methodology, engaging clinicians in QI activities can be challenging, and there is often a lack of integration and coordination among QI functions (eg, Departments of Quality and Safety, Continuing Professional Development). In our AMC, we undertook a collaborative approach to achieve better vertical and horizontal integration of our QI education efforts. This article provides a case example describing our organizational context, what was done, and with what effect and makes our example and lessons learned available to others. We developed a new educational QI program that was jointly planned and implemented by a group comprising major QI stakeholders. This project was intended to create horizontal organizational linkages between continuing professional development, clinicians, the hospital, and QI department and produce QI activities that aligned with the strategic objectives of senior management. The group developed and implemented a curriculum based on Lean methodology and concepts from the Institute for Health Care Improvement Model for Improvement. Two cohorts (27 teams) completed the training and planned and implemented QI projects. All projects were aligned with organizational quality, safety, and patient experience goals. The majority of projects met their aim statements. This case description provides an example of successful horizontal integration of an AMCs' QI functions to disseminate knowledge and implement meaningful QI aligned with strategic objectives (vertical integration).

  19. Social network approaches to leadership: an integrative conceptual review.

    Science.gov (United States)

    Carter, Dorothy R; DeChurch, Leslie A; Braun, Michael T; Contractor, Noshir S

    2015-05-01

    Contemporary definitions of leadership advance a view of the phenomenon as relational, situated in specific social contexts, involving patterned emergent processes, and encompassing both formal and informal influence. Paralleling these views is a growing interest in leveraging social network approaches to study leadership. Social network approaches provide a set of theories and methods with which to articulate and investigate, with greater precision and rigor, the wide variety of relational perspectives implied by contemporary leadership theories. Our goal is to advance this domain through an integrative conceptual review. We begin by answering the question of why-Why adopt a network approach to study leadership? Then, we offer a framework for organizing prior research. Our review reveals 3 areas of research, which we term: (a) leadership in networks, (b) leadership as networks, and (c) leadership in and as networks. By clarifying the conceptual underpinnings, key findings, and themes within each area, this review serves as a foundation for future inquiry that capitalizes on, and programmatically builds upon, the insights of prior work. Our final contribution is to advance an agenda for future research that harnesses the confluent ideas at the intersection of leadership in and as networks. Leadership in and as networks represents a paradigm shift in leadership research-from an emphasis on the static traits and behaviors of formal leaders whose actions are contingent upon situational constraints, toward an emphasis on the complex and patterned relational processes that interact with the embedding social context to jointly constitute leadership emergence and effectiveness. (c) 2015 APA, all rights reserved.

  20. Architecture of portable electronic medical records system integrated with streaming media.

    Science.gov (United States)

    Chen, Wei; Shih, Chien-Chou

    2012-02-01

    Due to increasing occurrence of accidents and illness during business trips, travel, or overseas studies, the requirement for portable EMR (Electronic Medical Records) has increased. This study proposes integrating streaming media technology into the EMR system to facilitate referrals, contracted laboratories, and disease notification among hospitals. The current study encoded static and dynamic medical images of patients into a streaming video format and stored them in a Flash Media Server (FMS). Based on the Taiwan Electronic Medical Record Template (TMT) standard, EMR records can be converted into XML documents and used to integrate description fields with embedded streaming videos. This investigation implemented a web-based portable EMR interchanging system using streaming media techniques to expedite exchanging medical image information among hospitals. The proposed architecture of the portable EMR retrieval system not only provides local hospital users the ability to acquire EMR text files from a previous hospital, but also helps access static and dynamic medical images as reference for clinical diagnosis and treatment. The proposed method protects property rights of medical images through information security mechanisms of the Medical Record Interchange Service Center and Health Certificate Authorization to facilitate proper, efficient, and continuous treatment of patients.

  1. An integrated approach to risk assessment and mitigating the CBRN threat

    International Nuclear Information System (INIS)

    Bokan, S.

    2009-01-01

    CBRN mass casualty events threat mitigation remains today the highest international priority. Although significant progress has been made, the national security requirements for efforts to combat Weapons of Mass Destruction and Weapons of Mass Disruption will be of the highest national priority in the near future. An integration of a number of approaches is essential in the risk assessment and mitigating the CBRN treat. Preparedness measures and procedures, engineering, science and technology, policy, medical, and emergency response are essential to reduce the threat from the proliferation and use of weapons of mass destruction (WMD). Improved coordination between international, public and private security entities is also essential task to hopefully prevent the terrorist attacks. In this lecture, it will be presented very important scientific approach to risk assessment of potential use of nuclear, radiological, biological or chemical weapons in terrorist actions. An integrated approach for mitigating the CBRN threat, crisis management and preparedness measures for prevention and reduction of potential consequences, will be presented.(author)

  2. Towards a theory of integrity systems: a configurational approach

    NARCIS (Netherlands)

    Six, F.E.; Lawton, A.

    2013-01-01

    The integrity of public officials is considered a key determinant of public trust in government and a central concept in good governance. An integrity system consists of all components, such as policies, practices, institutions and integrity guardians meant to contribute to the integrity of the

  3. Development of a case-based integrated nutrition curriculum for medical students.

    Science.gov (United States)

    Hark, L A; Morrison, G

    2000-09-01

    The Nutrition Education and Prevention Program at the University of Pennsylvania School of Medicine is a successful program that can be used as a model for the development and implementation of a case-based nutrition curriculum across the 4-y medical school experience. This article gives a broad overview of the development, implementation, evaluation, and dissemination processes used by the Nutrition Education and Prevention Program administration and core faculty group at the University of Pennsylvania School of Medicine. Beginning in 1990, the nutrition curriculum was initiated with the assistance of several funding sources. The program was structured using a multidisciplinary faculty group of physicians and registered dietitians from multiple departments, centers, and institutes. The outcome of this process is a textbook, Medical Nutrition and Disease, currently required by numerous medical schools, residency programs, and other health professional programs across the nation. With the use of data from the Association of American Medical Colleges All Schools Survey of Graduating Medical Students, perceptions of the adequacy of nutrition education were tracked over time. In 1991, 80% of University of Pennsylvania medical students felt that nutrition coverage was inadequate compared with 10% of medical students in 1998, a significant change resulting from the nutrition program's effect. The University of Pennsylvania School of Medicine has developed and implemented a successful nutrition curriculum, despite national trends. The case-based integrated curricular model presented in Medical Nutrition and Disease and on our Web site, www.med.upenn.edu/nutrimed, can be used by medical institutions and other health professionals.

  4. Validity of Oxygen-Ozone Therapy as Integrated Medication Form in Chronic Inflammatory Diseases.

    Science.gov (United States)

    Bocci, Velio; Zanardia, Iacopo; Valacchi, Giuseppe; Borrelli, Emma; Travagli, Valter

    2015-01-01

    The state-of-the-art of oxygen-ozone therapy is now clarified and all the mechanisms of action of medical ozone are within classical biochemistry and molecular biology. The outcomes of standard treatments in peripheral arterial occlusive disease (PAOD) and dry-form of age-related macular degeneration (AMD) have been compared with the documented therapeutic results achieved with ozonated autohemotherapy (O-AHT). On the other hand, the clinical data of O-AHT on stroke remain indicative. As the cost of O-AHT is almost irrelevant, its application in all public hospitals, especially those of poor Countries, would allow two advantages: the first is for the patient, who will improve her/his conditions, and the second is for Health Authorities burdened with increasing costs. The aim of this paper is to report to clinical scientists that O-AHT is a scientific-based therapeutic approach without side effects. The integration of O-AHT with effective approved drugs is likely to yield the best clinical results in several chronic inflammatory diseases.

  5. Heuristics: foundations for a novel approach to medical decision making.

    Science.gov (United States)

    Bodemer, Nicolai; Hanoch, Yaniv; Katsikopoulos, Konstantinos V

    2015-03-01

    Medical decision-making is a complex process that often takes place during uncertainty, that is, when knowledge, time, and resources are limited. How can we ensure good decisions? We present research on heuristics-simple rules of thumb-and discuss how medical decision-making can benefit from these tools. We challenge the common view that heuristics are only second-best solutions by showing that they can be more accurate, faster, and easier to apply in comparison to more complex strategies. Using the example of fast-and-frugal decision trees, we illustrate how heuristics can be studied and implemented in the medical context. Finally, we suggest how a heuristic-friendly culture supports the study and application of heuristics as complementary strategies to existing decision rules.

  6. An Approach to Establishing International Quality Standards for Medical Travel.

    Science.gov (United States)

    Kácha, Ondřej; Kovács, Beáta E; McCarthy, Cormac; Schuurmans, Angela A T; Dobyns, Christopher; Haller, Elisa; Hinrichs, Saba; Ruggeri, Kai

    2016-01-01

    The number of individuals traveling abroad is increasing annually. The rising popularity of medical travel and the absence of clear minimum quality requirements in this area urgently call for the development of international standards to ensure good practice and patient safety. The aim of this study is to identify the key domains in medical travel where quality standards should be established. Drawing from the evidence-based OECD framework and an extensive literature review, this study proposes three critical areas for consideration: minimum standards of health-care facilities and third-party agencies, financial responsibility, and patient centeredness. Several cultural challenges have been introduced that may pose a barrier to development of the guidelines and should be taken into consideration. Establishing international quality standards in medical travel enhances benefits to patients and providers, which is an urgent necessity given the rapid growth in this industry.

  7. An integrated approach to telemonitoring noncommunicable diseases: best practice from the European innovation partnership on active and healthy ageing.

    Science.gov (United States)

    Bourret, Rodolphe; Bousquet, Jean

    2013-01-01

    The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has prioritized noncommunicable diseases (NCDs). An innovative integrated health system built around medical systems and strategic partnerships is proposed to combat NCDs. Information and communication technology (ICT) is needed for the implementation of integrated care in a medical systems approach. The Teaching Hospital of Montpellier has set up the clinic and uses IP-Soins as an ICT tool. Patients with NCDs will be referred to the chronic disease clinic of the hospital by a primary care physician. This paper reviews the complexity of NCDs intertwined with ageing. It gives an overview of the problem. It presents an innovative approach in the implementation of a clinical information system in a "SaaS" (Software as a Service) mode.

  8. Optimization approach for saddling cost of medical cyclotrons with fuzziness

    International Nuclear Information System (INIS)

    Abass, S.A.; Massoud, E.M.A.

    2007-01-01

    Most radiation fields are combinations of different kinds of radiation. The radiations of most significance are fast neutrons, thermal neutrons, primary gammas and secondary gammas. Thermos's composite shielding materials are designed to attenuate these types of radiation. The shielding design requires an accurate cost-benefit analysis based on uncertainty optimization technique. The theory of fuzzy sets has been employed to formulate and solve the problem of cost-benefit analysis of medical cyclotron. This medical radioisotope production cyclotron is based in Sydney, Australia

  9. A novel system architecture for the national integration of electronic health records: a semi-centralized approach.

    Science.gov (United States)

    AlJarullah, Asma; El-Masri, Samir

    2013-08-01

    The goal of a national electronic health records integration system is to aggregate electronic health records concerning a particular patient at different healthcare providers' systems to provide a complete medical history of the patient. It holds the promise to address the two most crucial challenges to the healthcare systems: improving healthcare quality and controlling costs. Typical approaches for the national integration of electronic health records are a centralized architecture and a distributed architecture. This paper proposes a new approach for the national integration of electronic health records, the semi-centralized approach, an intermediate solution between the centralized architecture and the distributed architecture that has the benefits of both approaches. The semi-centralized approach is provided with a clearly defined architecture. The main data elements needed by the system are defined and the main system modules that are necessary to achieve an effective and efficient functionality of the system are designed. Best practices and essential requirements are central to the evolution of the proposed architecture. The proposed architecture will provide the basis for designing the simplest and the most effective systems to integrate electronic health records on a nation-wide basis that maintain integrity and consistency across locations, time and systems, and that meet the challenges of interoperability, security, privacy, maintainability, mobility, availability, scalability, and load balancing.

  10. Integration of medical imaging including ultrasound into a new clinical anatomy curriculum.

    Science.gov (United States)

    Moscova, Michelle; Bryce, Deborah A; Sindhusake, Doungkamol; Young, Noel

    2015-01-01

    In 2008 a new clinical anatomy curriculum with integrated medical imaging component was introduced into the University of Sydney Medical Program. Medical imaging used for teaching the new curriculum included normal radiography, MRI, CT scans, and ultrasound imaging. These techniques were incorporated into teaching over the first two years of the program as a part of anatomy practical sessions, in addition to dedicated lectures and tutorials given by imaging specialists. Surveys were conducted between 2009 and 2012 to evaluate the student acceptance of the integration. Students were asked to rate individual activities as well as provide open-ended comments. The number of students who responded to the surveys varied from 40% to 98%. Over 90% of the respondents were satisfied with the overall quality of teaching in the anatomy units. In summary, 48% to 63% of the responding students thought that the specialist imaging lectures helped them learn effectively; 72% to 77% of students thought that the cross-sectional practical sessions helped them to better understand the imaging modalities of CT, MRI, and ultrasound; 76% to 80% of students considered hands-on ultrasound session to be useful in understanding the application of ultrasound in abdominal imaging. The results also revealed key similarities and differences in student perceptions of the new integrated curriculum for students with both a high and low prior exposure to anatomy. Further evaluation will aid in refining the integrated medical imaging program and providing its future direction. © 2014 American Association of Anatomists.

  11. Towards a fully-fledged integration of spiritual care and medical care

    NARCIS (Netherlands)

    Kruizinga, R.; Scherer-Rath, M.; Schilderman, J.B.A.M.; Puchalski, C.; Laarhoven, H.W.M. van

    2018-01-01

    In this article, we aimed to set out current problems that hinder a fully fledged integration of spiritual and medical care, which address these obstacles. We discuss the following five statements: 1) spiritual care requires a clear and inclusive definition of spirituality; 2) empirical evidence for

  12. 1 Reevaluation of the integrated horizontal flux approach

    Science.gov (United States)

    Neftel, Albrecht; Häni, Christoph; Hensen, Arjan

    2017-04-01

    The integrated horizontal flux (IHF) method is a simplified mass balance approach frequently used to determine emissions from confined source areas, e.g. NH3 emissions from slurry spread to a circular plot (Denmead, 2008). With a mast in the center of the circle with radius R, the total flux F of the upwind emitted NH3 is approximated from the measured vertical (z) profiles of concentration (c) and horizontal wind speed (u) as (Denmead 1983): F = 1/R\\intz=zplz=0\\overline{u(c - cbgd)}dz where cbgd is the ``background'' concentration upwind of the emitting area and zpl is the maximum height of the emission plume (where the concentration c equals cbgd).The IHF method is a robust approach, as it is independent of surface characteristics and the state of atmospheric diffusion (Denmead, 2008; Laubach,2010). Ryden and McNeill (1984) published guidelines on how to evaluate IHF measurements, which have been used in many investigations that followed. In the following we analyze systematic biases that might occur by applying different recipes to both modelled concentration profiles as well as measured profiles from a recent field experiment in the Netherlands. Typical differencs using the approach by Ryden et al. (1984) are in the order +10% to +30% compared to the reference values from the model or alternative determination of the emissions based on the experimental values. The positive biases consist of several contributions: horizontal diffusion, logarithmic fit of the concentration profile, displacement height. References Denmead, O. T., 1983. Micrometeorological methods for measuring gaseous losses of nitrogen in the field. In: Gaseous Loss of Nitrogen from Plum-Soil Systems (Freney, J. R.; Simpson, J. R., Eds) Martinus Nijhof/Dr W. Junk, The Hague, pp. 133-157. Denmead, O. T., 2008. Approaches to measuring fluxes of methane and nitrous oxide between landscapes and the atmosphere. Plant Soil 309 (1-2), 5a\\euro 24.Laubach, J., 2010. Testing of a lagrangian model of

  13. Striving for Better Medical Education: the Simulation Approach.

    Science.gov (United States)

    Sakakushev, Boris E; Marinov, Blagoi I; Stefanova, Penka P; Kostianev, Stefan St; Georgiou, Evangelos K

    2017-06-01

    Medical simulation is a rapidly expanding area within medical education due to advances in technology, significant reduction in training hours and increased procedural complexity. Simulation training aims to enhance patient safety through improved technical competency and eliminating human factors in a risk free environment. It is particularly applicable to a practical, procedure-orientated specialties. Simulation can be useful for novice trainees, experienced clinicians (e.g. for revalidation) and team building. It has become a cornerstone in the delivery of medical education, being a paradigm shift in how doctors are educated and trained. Simulation must take a proactive position in the development of metric-based simulation curriculum, adoption of proficiency benchmarking definitions, and should not depend on the simulation platforms used. Conversely, ingraining of poor practice may occur in the absence of adequate supervision, and equipment malfunction during the simulation can break the immersion and disrupt any learning that has occurred. Despite the presence of high technology, there is a substantial learning curve for both learners and facilitators. The technology of simulation continues to advance, offering devices capable of improved fidelity in virtual reality simulation, more sophisticated procedural practice and advanced patient simulators. Simulation-based training has also brought about paradigm shifts in the medical and surgical education arenas and ensured that the scope and impact of simulation will continue to broaden.

  14. An active learning approach to the physics of medical imaging

    DEFF Research Database (Denmark)

    Wilhjelm, J.E.; Pihl, M.J.; Jensen, M.

    2008-01-01

    This paper describes an experimentally oriented medical imaging course where the students record, process and analyse 3D data of an unknown piece of formalin fixed porcine tissue hidden in agar in order to estimate the tissue types present in a selected 2D slice. The recorded planar X-ray, CT, MR...

  15. An approach to establishing international quality standards for medical travel

    NARCIS (Netherlands)

    Lácha, O.; Kovács, B.E.; McCarthy, C.; Schuurmans, A.T.; Dobyns, C.; Haller, E.; Hinrichs, S.; Ruggeri, K.

    2016-01-01

    Traveling abroad to receive a non-elective treatment is expanding each year. Such rising popularity of medical travel and the absence of clear minimum quality requirements in this area urgently calls for setting international standards to ensure good practice and patient safety. The aim of this

  16. Interventions to promote an integrated approach to public health problems : an application to childhood obesity

    NARCIS (Netherlands)

    Hendriks, Anna-Marie; Gubbels, Jessica S; De Vries, Nanne K.; Seidell, Jaap C; Kremers, Stef P J; Jansen, Maria W J

    2012-01-01

    Experts stress the need to bring the childhood obesity epidemic under control by means of an integrated approach. The implementation of such an approach requires the development of integrated enabling policies on public health by local governments. A prerequisite for developing such integrated

  17. Student perceptions of independent versus facilitated small group learning approaches to compressed medical anatomy education.

    Science.gov (United States)

    Whelan, Alexander; Leddy, John J; Mindra, Sean; Matthew Hughes, J D; El-Bialy, Safaa; Ramnanan, Christopher J

    2016-01-01

    The purpose of this study was to compare student perceptions regarding two, small group learning approaches to compressed (46.5 prosection-based laboratory hours), integrated anatomy education at the University of Ottawa medical program. In the facilitated active learning (FAL) approach, tutors engage students and are expected to enable and balance both active learning and progression through laboratory objectives. In contrast, the emphasized independent learning (EIL) approach stresses elements from the "flipped classroom" educational model: prelaboratory preparation, independent laboratory learning, and limited tutor involvement. Quantitative (Likert-style questions) and qualitative data (independent thematic analysis of open-ended commentary) from a survey of students who had completed the preclerkship curriculum identified strengths from the EIL (promoting student collaboration and communication) and FAL (successful progression through objectives) approaches. However, EIL led to student frustration related to a lack of direction and impaired completion of objectives, whereas active learning opportunities in FAL were highly variable and dependent on tutor teaching style. A "hidden curriculum" was also identified, where students (particularly EIL and clerkship students) commonly compared their compressed anatomy education or their anatomy learning environment with other approaches. Finally, while both groups highly regarded the efficiency of prosection-based learning and expressed value for cadaveric-based learning, student commentary noted that the lack of grade value dedicated to anatomy assessment limited student accountability. This study revealed critical insights into small group learning in compressed anatomy education, including the need to balance student active learning opportunities with appropriate direction and feedback (including assessment). © 2015 American Association of Anatomists.

  18. Development of a longitudinal integrated clerkship at an academic medical center.

    Science.gov (United States)

    Poncelet, Ann; Bokser, Seth; Calton, Brook; Hauer, Karen E; Kirsch, Heidi; Jones, Tracey; Lai, Cindy J; Mazotti, Lindsay; Shore, William; Teherani, Arianne; Tong, Lowell; Wamsley, Maria; Robertson, Patricia

    2011-04-04

    In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

  19. Development of a longitudinal integrated clerkship at an academic medical center

    Directory of Open Access Journals (Sweden)

    Ann Poncelet

    2011-04-01

    Full Text Available In 2005, medical educators at the University of California, San Francisco (UCSF, began developing the Parnassus Integrated Student Clinical Experiences (PISCES program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants’ career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

  20. Inspector training for VIFM equipment - An integrated approach

    International Nuclear Information System (INIS)

    Truong, Q.S. Bob; Keeffe, R.; Ellacott, T.; Desson, K.; Herber, N.

    2001-01-01

    Full text: The VXI Integrated Fuel Monitor (VIFM) was developed by the Canadian Safeguards Support Program (CSSP) as a generic radiation monitor for safeguards applications. The VIFM equipment features a modular design, where a single cabinet can house several instruments such as bundle counters, core discharge monitors, Yes/No monitors, and other devices. VIFM can also be used in a stand-alone, transportable mode, with a detector connected to a single VIFM module linked to a laptop computer. VIFM equipment is currently in use at CANDU nuclear generating stations in several countries. Because each facility may have a different combination of detectors, the training program has been designed to reflect the modular nature of VIFM. Introductory material is generic and applies to any facility. More advanced material is carefully compartmentalized to allow IAEA Inspectors to concentrate their efforts in areas that concern them. Advanced material is available in a just-in-time reference format that simplifies rapid access to detailed information. A number of training resources have been developed, including multimedia and video material on CD-ROMs. This material has been designed to operate on a laptop computer, allowing inspectors to review and refresh their knowledge at any time - for example, during inspection trips. Although each of these resources is useful in its own right, the CSSP is developing an integrated approach to inspector training that combines all of these elements in a new way calculated to produce better training results than in the past. This new training approach features a two-day workshop preceded by a period of CD-ROM-based self-paced study. After the workshop, participants are able to make use of printed and CD-ROM-based reference materials for just-in-time 'refreshers'. Each step in this integrated approach to training will be described in the presentation. Briefly, the steps are as follows. A multimedia computer-based training package is made

  1. Looping probabilities of elastic chains: a path integral approach.

    Science.gov (United States)

    Cotta-Ramusino, Ludovica; Maddocks, John H

    2010-11-01

    We consider an elastic chain at thermodynamic equilibrium with a heat bath, and derive an approximation to the probability density function, or pdf, governing the relative location and orientation of the two ends of the chain. Our motivation is to exploit continuum mechanics models for the computation of DNA looping probabilities, but here we focus on explaining the novel analytical aspects in the derivation of our approximation formula. Accordingly, and for simplicity, the current presentation is limited to the illustrative case of planar configurations. A path integral formalism is adopted, and, in the standard way, the first approximation to the looping pdf is obtained from a minimal energy configuration satisfying prescribed end conditions. Then we compute an additional factor in the pdf which encompasses the contributions of quadratic fluctuations about the minimum energy configuration along with a simultaneous evaluation of the partition function. The original aspects of our analysis are twofold. First, the quadratic Lagrangian describing the fluctuations has cross-terms that are linear in first derivatives. This, seemingly small, deviation from the structure of standard path integral examples complicates the necessary analysis significantly. Nevertheless, after a nonlinear change of variable of Riccati type, we show that the correction factor to the pdf can still be evaluated in terms of the solution to an initial value problem for the linear system of Jacobi ordinary differential equations associated with the second variation. The second novel aspect of our analysis is that we show that the Hamiltonian form of these linear Jacobi equations still provides the appropriate correction term in the inextensible, unshearable limit that is commonly adopted in polymer physics models of, e.g. DNA. Prior analyses of the inextensible case have had to introduce nonlinear and nonlocal integral constraints to express conditions on the relative displacement of the end

  2. Innovative levers for sustainable integration of gender medicine into medical school curricula.

    Science.gov (United States)

    Tannenbaum, Cara; Moineau, Geneviève

    2016-01-01

    Efforts to integrate gender medicine into medical school curricula have focused largely on the work of individual champions. Online sex and gender materials for undergraduate courses have also been developed and disseminated. Success has been sporadic, with varying uptake across schools within and between countries. International trends in medical school accreditation processes and the growing force of the millennial student voice offer untapped opportunities to promote more systematic integration of gender medicine on a national and international level. In this commentary, the president and CEO of the Association of Faculties of Medicine of Canada and the Scientific Director of the Institute of Gender and Health of the Canadian Institutes of Health Research jointly reflect on top-down and bottom-up levers for sustainable innovation in gender medicine for undergraduate medical training.

  3. Embedding a Palliative Approach in Nursing Care Delivery: An Integrated Knowledge Synthesis.

    Science.gov (United States)

    Sawatzky, Richard; Porterfield, Pat; Roberts, Della; Lee, Joyce; Liang, Leah; Reimer-Kirkham, Sheryl; Pesut, Barb; Schalkwyk, Tilly; Stajduhar, Kelli; Tayler, Carolyn; Baumbusch, Jennifer; Thorne, Sally

    A palliative approach involves adapting and integrating principles and values from palliative care into the care of persons who have life-limiting conditions throughout their illness trajectories. The aim of this research was to determine what approaches to nursing care delivery support the integration of a palliative approach in hospital, residential, and home care settings. The findings substantiate the importance of embedding the values and tenets of a palliative approach into nursing care delivery, the roles that nurses have in working with interdisciplinary teams to integrate a palliative approach, and the need for practice supports to facilitate that embedding and integration.

  4. Approaches to cancer assessment in EPA's Integrated Risk Information System

    International Nuclear Information System (INIS)

    Gehlhaus, Martin W.; Gift, Jeffrey S.; Hogan, Karen A.; Kopylev, Leonid; Schlosser, Paul M.; Kadry, Abdel-Razak

    2011-01-01

    The U.S. Environmental Protection Agency's (EPA) Integrated Risk Information System (IRIS) Program develops assessments of health effects that may result from chronic exposure to chemicals in the environment. The IRIS database contains more than 540 assessments. When supported by available data, IRIS assessments provide quantitative analyses of carcinogenic effects. Since publication of EPA's 2005 Guidelines for Carcinogen Risk Assessment, IRIS cancer assessments have implemented new approaches recommended in these guidelines and expanded the use of complex scientific methods to perform quantitative dose-response assessments. Two case studies of the application of the mode of action framework from the 2005 Cancer Guidelines are presented in this paper. The first is a case study of 1,2,3-trichloropropane, as an example of a chemical with a mutagenic mode of carcinogenic action thus warranting the application of age-dependent adjustment factors for early-life exposure; the second is a case study of ethylene glycol monobutyl ether, as an example of a chemical with a carcinogenic action consistent with a nonlinear extrapolation approach. The use of physiologically based pharmacokinetic (PBPK) modeling to quantify interindividual variability and account for human parameter uncertainty as part of a quantitative cancer assessment is illustrated using a case study involving probabilistic PBPK modeling for dichloromethane. We also discuss statistical issues in assessing trends and model fit for tumor dose-response data, analysis of the combined risk from multiple types of tumors, and application of life-table methods for using human data to derive cancer risk estimates. These issues reflect the complexity and challenges faced in assessing the carcinogenic risks from exposure to environmental chemicals, and provide a view of the current trends in IRIS carcinogenicity risk assessment.

  5. Approaches to cancer assessment in EPA's Integrated Risk Information System.

    Science.gov (United States)

    Gehlhaus, Martin W; Gift, Jeffrey S; Hogan, Karen A; Kopylev, Leonid; Schlosser, Paul M; Kadry, Abdel-Razak

    2011-07-15

    The U.S. Environmental Protection Agency's (EPA) Integrated Risk Information System (IRIS) Program develops assessments of health effects that may result from chronic exposure to chemicals in the environment. The IRIS database contains more than 540 assessments. When supported by available data, IRIS assessments provide quantitative analyses of carcinogenic effects. Since publication of EPA's 2005 Guidelines for Carcinogen Risk Assessment, IRIS cancer assessments have implemented new approaches recommended in these guidelines and expanded the use of complex scientific methods to perform quantitative dose-response assessments. Two case studies of the application of the mode of action framework from the 2005 Cancer Guidelines are presented in this paper. The first is a case study of 1,2,3-trichloropropane, as an example of a chemical with a mutagenic mode of carcinogenic action thus warranting the application of age-dependent adjustment factors for early-life exposure; the second is a case study of ethylene glycol monobutyl ether, as an example of a chemical with a carcinogenic action consistent with a nonlinear extrapolation approach. The use of physiologically based pharmacokinetic (PBPK) modeling to quantify interindividual variability and account for human parameter uncertainty as part of a quantitative cancer assessment is illustrated using a case study involving probabilistic PBPK modeling for dichloromethane. We also discuss statistical issues in assessing trends and model fit for tumor dose-response data, analysis of the combined risk from multiple types of tumors, and application of life-table methods for using human data to derive cancer risk estimates. These issues reflect the complexity and challenges faced in assessing the carcinogenic risks from exposure to environmental chemicals, and provide a view of the current trends in IRIS carcinogenicity risk assessment. Copyright © 2011. Published by Elsevier Inc.

  6. Integration of the HTC Vive into the medical platform MeVisLab

    Science.gov (United States)

    Egger, Jan; Gall, Markus; Wallner, Jürgen; de Almeida Germano Boechat, Pedro; Hann, Alexander; Li, Xing; Chen, Xiaojun; Schmalstieg, Dieter

    2017-03-01

    Virtual Reality (VR) is an immersive technology that replicates an environment via computer-simulated reality. VR gets a lot of attention in computer games but has also great potential in other areas, like the medical domain. Examples are planning, simulations and training of medical interventions, like for facial surgeries where an aesthetic outcome is important. However, importing medical data into VR devices is not trivial, especially when a direct connection and visualization from your own application is needed. Furthermore, most researcher don't build their medical applications from scratch, rather they use platforms, like MeVisLab, Slicer or MITK. The platforms have in common that they integrate and build upon on libraries like ITK and VTK, further providing a more convenient graphical interface to them for the user. In this contribution, we demonstrate the usage of a VR device for medical data under MeVisLab. Therefore, we integrated the OpenVR library into MeVisLab as an own module. This enables the direct and uncomplicated usage of head mounted displays, like the HTC Vive under MeVisLab. Summarized, medical data from other MeVisLab modules can directly be connected per drag-and-drop to our VR module and will be rendered inside the HTC Vive for an immersive inspection.

  7. Effects of interdisciplinary collaboration in hospitals on medication errors: an integrative review.

    Science.gov (United States)

    Manias, Elizabeth

    2018-03-01

    Medication errors are commonly affected by breakdowns in communication. Interdisciplinary collaboration is an important means of facilitating communication between health professionals in clinical practice. To date, there has been little systematic examination of past research in this area. Areas covered: The aims of this integrative review are to examine how interdisciplinary collaboration influences medication errors in hospitals, the araes of interdisciplinary collaboration that have been researched in previous work, and recommendations for future research and practice. An integrative review was undertaken of research papers (N = 30) published from inception to August 2017 using MEDLINE, the Cochrane Library, CINAHL, PsycINFO, and Embase. Expert opinion: Five different areas of interdisciplinary collaboration were identified in research involving medication errors. These areas were: communication through tools including guidelines, protocols, and communication logs; participation of pharmacists in interdisciplinary teams; collaborative medication review on admission and at discharge; collaborative workshops and conferences; and complexity of role differentiation and environment. Despite encouraging results demonstrated in past research, medication errors continued to occur. Increased focus is needed on developing tailored, individualized strategies that can be applied in particular contexts to create further reductions in medication errors. Greater understandings are also needed about the changing roles of various disciplines.

  8. Integrated Medical-Dental Delivery Systems: Models in a Changing Environment and Their Implications for Dental Education.

    Science.gov (United States)

    Jones, Judith A; Snyder, John J; Gesko, David S; Helgeson, Michael J

    2017-09-01

    Models and systems of the dental care delivery system are changing. Solo practice is no longer the only alternative for graduating dentists. Over half of recent graduates are employees, and more than ever before, dentists are practicing in groups. This trend is expected to increase over the next 25 years. This article examines various models of dental care delivery, explains why it is important to practice in integrated medical-dental teams, and defines person-centered care, contrasting it with patient-centered care. Systems of care in which teams are currently practicing integrated oral health care delivery are described, along with speculation on the future of person-centered care and the team approach. Critical steps in the education of dental and other health care professionals and the development of clinical models of care in moving forward are considered. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

  9. Evolutionary algorithms approach for integrated bioenergy supply chains optimization

    International Nuclear Information System (INIS)

    Ayoub, Nasser; Elmoshi, Elsayed; Seki, Hiroya; Naka, Yuji

    2009-01-01

    In this paper, we propose an optimization model and solution approach for designing and evaluating integrated system of bioenergy production supply chains, SC, at the local level. Designing SC that simultaneously utilize a set of bio-resources together is a complicated task, considered here. The complication arises from the different nature and sources of bio-resources used in bioenergy production i.e., wet, dry or agriculture, industrial etc. Moreover, the different concerns that decision makers should take into account, to overcome the tradeoff anxieties of the socialists and investors, i.e., social, environmental and economical factors, was considered through the options of multi-criteria optimization. A first part of this research was introduced in earlier research work explaining the general Bioenergy Decision System gBEDS [Ayoub N, Martins R, Wang K, Seki H, Naka Y. Two levels decision system for efficient planning and implementation of bioenergy production. Energy Convers Manage 2007;48:709-23]. In this paper, brief introduction and emphasize on gBEDS are given; the optimization model is presented and followed by a case study on designing a supply chain of nine bio-resources at Iida city in the middle part of Japan.

  10. Integrated approach in the treatment of metabolic syndrome

    Directory of Open Access Journals (Sweden)

    V A Uchamprina

    2014-03-01

    Full Text Available The Goal of this study was to investigate the efficacy of the integrated approach for the treatment of metabolic syndrome (MS aiming to correct all of its components versus standard therapy using clinical outcomes (BMI, waist circumference, blood pressure, lipid levels, assessment of psychological status (Beck Depression Inventory, and quality of life (SF-36. Methods: A total of 60 patients with MS were included in the study. The study group (30 subjects mean age 41.0±11 years, women - 23 (76.7%, men - 7 (23.3% received the complex therapy of MS - pharmacotherapy of obesity (orlistat and insulin resistance (metformin, lipid-lowering therapy (statins or fibrates, antihypertensive therapy. Control group (30 patients mean age 43.4±9.5 years, women - 26 (86.7%, men - 4 (13.3% was treated with statins or fibrates and received antihypertensive therapy when needed. At the inclusion in the study and after 6 months of therapy all patients underwent clinical and laboratory investigation, assessment of depression and quality of life. Results: We found a more significant reduction of all clinical outcomes (body weight, blood pressure, improvement in glucose and lipid metabolism, a significant decrease in the prevalence and severity of the depression, and an improvement in the quality of life in patients of study group compared with standard therapy. Conclusion: Complex treatment of the MS, including pharmacotherapy of obesity (orlistat, Xenical and insulin resistance (metformin, Glucophage is characterized by a greater clinical efficacy compared with standard therapy.

  11. An integrated and pragmatic approach: Global plant safety management

    Science.gov (United States)

    McNutt, Jack; Gross, Andrew

    1989-05-01

    The Bhopal disaster in India in 1984 has compelled manufacturing companies to review their operations in order to minimize their risk exposure. Much study has been done on the subject of risk assessment and in refining safety reviews of plant operations. However, little work has been done to address the broader needs of decision makers in the multinational environment. The corporate headquarters of multinational organizations are concerned with identifying vulnerable areas to assure that appropriate risk-minimization measures are in force or will be taken. But the task of screening global business units for safety prowess is complicated and time consuming. This article takes a step towards simplifying this process by presenting the decisional model developed by the authors. Beginning with an overview of key issues affecting global safety management, the focus shifts to the multinational vulnerability model developed by the authors, which reflects an integration of approaches. The article concludes with a discussion of areas for further research. While the global chemical industry and major incidents therein are used for illustration, the procedures and solutions suggested here are applicable to all manufacturing operations.

  12. HIPred: an integrative approach to predicting haploinsufficient genes.

    Science.gov (United States)

    Shihab, Hashem A; Rogers, Mark F; Campbell, Colin; Gaunt, Tom R

    2017-06-15

    A major cause of autosomal dominant disease is haploinsufficiency, whereby a single copy of a gene is not sufficient to maintain the normal function of the gene. A large proportion of existing methods for predicting haploinsufficiency incorporate biological networks, e.g. protein-protein interaction networks that have recently been shown to introduce study bias. As a result, these methods tend to perform best on well-studied genes, but underperform on less studied genes. The advent of large genome sequencing consortia, such as the 1000 genomes project, NHLBI Exome Sequencing Project and the Exome Aggregation Consortium creates an urgent need for unbiased haploinsufficiency prediction methods. Here, we describe a machine learning approach, called HIPred, that integrates genomic and evolutionary information from ENSEMBL, with functional annotations from the Encyclopaedia of DNA Elements consortium and the NIH Roadmap Epigenomics Project to predict haploinsufficiency, without the study bias described earlier. We benchmark HIPred using several datasets and show that our unbiased method performs as well as, and in most cases, outperforms existing biased algorithms. HIPred scores for all gene identifiers are available at: https://github.com/HAShihab/HIPred . h.shihab@bristol.ac.uk or tom.gaunt@bristol.ac.uk. Supplementary data are available at Bioinformatics online.

  13. Economic context and pigeons' risk-taking: an integrative approach.

    Science.gov (United States)

    Goldshmidt, J N; Fantino, E

    2004-02-27

    The present work tested pigeons' (Columba livia) risk sensitivity to changes in resource availability in the concurrent-chains choice procedure. Subjects were provided choices, generally between variable-ratio (VR) and fixed-ratio (FR) outcome schedules with equal or different mean values. Predictions from ecology's risk sensitivity, behavioral economic's rate maximization, and psychology's delay-reduction theory were contrasted under settings where budget was adversely affected by one of three manipulations in seven experiments: (1) session length was dramatically reduced; (2) choice-phase duration was substantially increased by increasing the response requirements in the choice phase, or (3) outcome duration was significantly increased by increasing the response requirements in the outcome phase while holding session length constant. Although preference measures were sensitive to every budget manipulation, the nature of the changes observed were dependent upon the manner in which resource availability was manipulated and the choice alternatives offered. For example, choice was affected in an opposite manner when budget was adversely altered by lengthening choice duration ("search time") as opposed to lengthening outcome duration ("handling time"). Findings revealed partial support for pigeons' sensitivity both to changes in budget and to changes in conditioned reinforcer value. The overall pattern of results thus favors an integrative approach to describing the effect of economic context on general risk sensitivity.

  14. Integrating complementary medicine literacy education into Australian medical curricula: Student-identified techniques and strategies for implementation.

    Science.gov (United States)

    Templeman, Kate; Robinson, Anske; McKenna, Lisa

    2015-11-01

    Formal medical education about complementary medicine (CM) that comprises medicinal products/treatments is required due to possible CM interactions with conventional medicines; however, few guidelines exist on design and implementation of such education. This paper reports findings of a constructivist grounded theory method study that identified key strategies for integrating CM literacy education into medical curricula. Analysis of data from interviews with 30 medical students showed that students supported a longitudinal integrative and pluralistic approach to medicine. Awareness of common patient use, evidence, and information relevant to future clinical practice were identified as focus points needed for CM literacy education. Students advocated for interactive case-based, experiential and dialogical didactic techniques that are multiprofessional and student-centred. Suggested strategies provide key elements of CM literacy within research, field-based practice, and didactic teaching over the entirety of the curriculum. CM educational strategies should address CM knowledge deficits and ultimately respond to patients' needs. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Medical or surgical approaches to obesity treatment, or both?

    OpenAIRE

    Cini, Erica

    2017-01-01

    Obesity is a growing concern in the medical profession, particularly due to the co-morbidities that are related to obesity. Various methods have been trialled to manage obesity with varying effects, but can we ever say that one which is better than the other? This article looks at various lifestyle, pharmacological and surgical aspects of the management of obesity and discusses the diverse theories as to why the maintenance of weight loss can be difficult.

  16. SYSTEMS ENGINEERING APPROACHES FOR IMPROVING REUSABLE MEDICAL EQUIPMENT REPROCESSING PROCESSES

    OpenAIRE

    JAMES C. BENNEYAN; CLAIRE BOND

    2013-01-01

    Hospital reusable medical equipment (RME) includes any items that are intended to be reprocessed and reused indefinitely, including surgical instruments, dental equipment, endoscopes, and others. Such equipment represent a significant portion of a hospital's inventory costs and recently have generated significant patient cross-contamination concerns due to reprocessing cleaning failures. This paper discusses recent applications of industrial and systems engineering (ISyE) methods within healt...

  17. Closing the False Divide: Sustainable Approaches to Integrating Mental Health Services into Primary Care.

    Science.gov (United States)

    Kroenke, Kurt; Unutzer, Jurgen

    2017-04-01

    Mental disorders account for 25% of all health-related disability worldwide. More patients receive treatment for mental disorders in the primary care sector than in the mental health specialty setting. However, brief visits, inadequate reimbursement, deficits in primary care provider (PCP) training, and competing demands often limit the capacity of the PCP to produce optimal outcomes in patients with common mental disorders. More than 80 randomized trials have shown the benefits of collaborative care (CC) models for improving outcomes of patients with depression and anxiety. Six key components of CC include a population-based approach, measurement-based care, treatment to target strategy, care management, supervision by a mental health professional (MHP), and brief psychological therapies. Multiple trials have also shown that CC for depression is equally or more cost-effective than many of the current treatments for medical disorders. Factors that may facilitate the implementation of CC include a more favorable alignment of medical and mental health services in accountable care organizations and patient-centered medical homes; greater use of telecare as well as automated outcome monitoring; identification of patients who might benefit most from CC; and systematic training of both PCPs and MHPs in integrated team-based care.

  18. Developing a fully integrated tobacco curriculum in medical colleges in India.

    Science.gov (United States)

    Yamini, T R; Nichter, Mark; Nichter, Mimi; Sairu, P; Aswathy, S; Leelamoni, K; Unnikrishnan, B; P, Prasanna Mithra; Thapar, Rekha; Basha, S R; Jayasree, A K; Mayamol, T R; Muramoto, Myra; Mini, G K; Thankappan, K R

    2015-05-20

    This paper describes a pioneering effort to introduce tobacco cessation into India's undergraduate medical college curriculum. This is the first ever attempt to fully integrate tobacco control across all years of medical college in any low and middle income country. The development, pretesting, and piloting of an innovative modular tobacco curriculum are discussed as well as challenges that face implementation and steps taken to address them and to advocate for adoption by the Medical Council of India. In-depth interviews were conducted with administrators and faculty in five medical colleges to determine interest in and willingness to fully integrate smoking cessation into the college curriculum. Current curriculum was reviewed for present exposure to information about tobacco and cessation skill training. A modular tobacco curriculum was developed, pretested, modified, piloted, and evaluated by faculty and students. Qualitative research was conducted to identify challenges to future curriculum implementation. Fifteen modules were successfully developed focusing on the public health importance of tobacco control, the relationship between tobacco and specific organ systems, diseases related to smoking and chewing tobacco, and the impact of tobacco on medication effectiveness. Culturally sensitive illness specific cessation training videos were developed. Faculty and students positively evaluated the curriculum as increasing their competency to support cessation during illness as a teachable moment. Students conducted illness centered cessation interviews with patients as a mandated part of their coursework. Systemic challenges to implementing the curriculum were identified and addressed. A fully integrated tobacco curriculum for medical colleges was piloted in 5 colleges and is now freely available online. The curriculum has been adopted by the state of Kerala as a first step to gaining Medical Council of India review and possible recognition.

  19. [Self-medication: a qualitative approach of its motivations].

    Science.gov (United States)

    Naves, Janeth de Oliveira Silva; Castro, Lia Lusitana Cardozo de; Carvalho, Christine Maria Soares de; Merchán-Hamann, Edgar

    2010-06-01

    A qualitative research was realized to verify the occurrence and motivations for self-medication and the quality of the information rendered by pharmacies. We conducted 3 focus groups with 25 patients of a reference public health service for STD treatment in Brasília, Brazil. We used the critical discourse analysis to interpret the data obtained during interviews. The analysis revealed that self-medication was a common practice among participants, motivated mainly by discontentment with the long waiting period and the quality of the public health services. Other motivations included: previous experience with medications, advice from friends and family members and the search for an anonymous service provided at pharmacies due to embarrassment and inadequate care environment at health care services. Care provided at pharmacies was also considered unsatisfactory. Viewed essentially as a commercial establishment, pharmacies have become, yet, an easy accessible alternative. Most of participants perceived the pharmacists as ordinary employees seeking only to increase profits. The results suggest a need to improve access to health care services, as well as to render it more humane. Community pharmacies should to be turned into health establishments to participate in health education and orientation for rational drugs use.

  20. Flipped classroom instructional approach in undergraduate medical education.

    Science.gov (United States)

    Fatima, Syeda Sadia; Arain, Fazal Manzoor; Enam, Syed Ather

    2017-01-01

    In this study we implemented the "flipped classroom" model to enhance active learning in medical students taking neurosciences module at Aga Khan University, Karachi. Ninety eight undergraduate medical students participated in this study. The study was conducted from January till March 2017. Study material was provided to students in form of video lecture and reading material for the non-face to face sitting, while face to face time was spent on activities such as case solving, group discussions, and quizzes to consolidate learning under the supervision of faculty. To ensure deeper learning, we used pre- and post-class quizzes, work sheets and blog posts for each session. Student feedback was recorded via a likert scale survey. Eighty four percent students gave positive responses towards utility of flipped classroom in terms of being highly interactive, thought provoking and activity lead learning. Seventy five percent of the class completed the pre-session preparation. Students reported that their queries and misconceptions were cleared in a much better way in the face-to-face session as compared to the traditional setting (4.09 ±1.04). Flipped classroom(FCR) teaching and learning pedagogy is an effective way of enhancing student engagement and active learning. Thus, this pedagogy can be used as an effective tool in medical schools.

  1. Building Thematic and Integrated Services for European Solid Earth Sciences: the EPOS Integrated Approach

    Science.gov (United States)

    Harrison, M.; Cocco, M.

    2017-12-01

    EPOS (European Plate Observing System) has been designed with the vision of creating a pan-European infrastructure for solid Earth science to support a safe and sustainable society. In accordance with this scientific vision, the EPOS mission is to integrate the diverse and advanced European Research Infrastructures for solid Earth science relying on new e-science opportunities to monitor and unravel the dynamic and complex Earth System. EPOS will enable innovative multidisciplinary research for a better understanding of the Earth's physical and chemical processes that control earthquakes, volcanic eruptions, ground instability and tsunami as well as the processes driving tectonics and Earth's surface dynamics. To accomplish its mission, EPOS is engaging different stakeholders, to allow the Earth sciences to open new horizons in our understanding of the planet. EPOS also aims at contributing to prepare society for geo-hazards and to responsibly manage the exploitation of geo-resources. Through integration of data, models and facilities, EPOS will allow the Earth science community to make a step change in developing new concepts and tools for key answers to scientific and socio-economic questions concerning geo-hazards and geo-resources as well as Earth sciences applications to the environment and human welfare. The research infrastructures (RIs) that EPOS is coordinating include: i) distributed geophysical observing systems (seismological and geodetic networks); ii) local observatories (including geomagnetic, near-fault and volcano observatories); iii) analytical and experimental laboratories; iv) integrated satellite data and geological information services; v) new services for natural and anthropogenic hazards; vi) access to geo-energy test beds. Here we present the activities planned for the implementation phase focusing on the TCS, the ICS and on their interoperability. We will discuss the data, data-products, software and services (DDSS) presently under

  2. Neurocognition, insight and medication nonadherence in schizophrenia: a structural equation modeling approach.

    Directory of Open Access Journals (Sweden)

    Laurent Boyer

    Full Text Available OBJECTIVE: The aim of this study was to examine the complex relationships among neurocognition, insight and nonadherence in patients with schizophrenia. METHODS: DESIGN: Cross-sectional study. INCLUSION CRITERIA: Diagnosis of schizophrenia according to the DSM-IV-TR criteria. DATA COLLECTION: Neurocognition was assessed using a global approach that addressed memory, attention, and executive functions; insight was analyzed using the multidimensional 'Scale to assess Unawareness of Mental Disorder;' and nonadherence was measured using the multidimensional 'Medication Adherence Rating Scale.' ANALYSIS: Structural equation modeling (SEM was applied to examine the non-straightforward relationships among the following latent variables: neurocognition, 'awareness of positive symptoms' and 'negative symptoms', 'awareness of mental disorder' and nonadherence. RESULTS: One hundred and sixty-nine patients were enrolled. The final testing model showed good fit, with normed χ(2 = 1.67, RMSEA = 0.063, CFI = 0.94, and SRMR = 0.092. The SEM revealed significant associations between (1 neurocognition and 'awareness of symptoms,' (2 'awareness of symptoms' and 'awareness of mental disorder' and (3 'awareness of mental disorder' and nonadherence, mainly in the 'attitude toward taking medication' dimension. In contrast, there were no significant links between neurocognition and nonadherence, neurocognition and 'awareness of mental disorder,' and 'awareness of symptoms' and nonadherence. CONCLUSIONS: Our findings support the hypothesis that neurocognition influences 'awareness of symptoms,' which must be integrated into a higher level of insight (i.e., the 'awareness of mental disorder' to have an impact on nonadherence. These findings have important implications for the development of effective strategies to enhance medication adherence.

  3. Development and initial feasibility of an organizational measure of behavioral health integration in medical care settings.

    Science.gov (United States)

    McGovern, Mark P; Urada, Darren; Lambert-Harris, Chantal; Sullivan, Steven T; Mazade, Noel A

    2012-12-01

    In the advent of health care reform, models are sought to integrate behavioral health and routine medical care services. Historically, the behavioral health specialty has not itself been integrated, but instead bifurcated by substance use and mental health across treatment systems, care providers and even research. With the present opportunity to transform the health care delivery system, it is incumbent upon policymakers, researchers and clinicians to avoid repeating this historical error, and provide integrated behavioral health services in medical contexts. An organizational measure designed to assess this capacity is described: the Dual Diagnosis Capability in Health Care Settings (DDCHCS). The DDCHCS was used to assess a sample of federally-qualified health centers (N=13) on the degree of behavioral health integration. The measure was found to be feasible and sensitive to detecting variation in integrated behavioral health services capacity. Three of the 13 agencies were dual diagnosis capable, with significant variation in DDCHCS dimensions measuring staffing, treatment practices and program milieu. In general, mental health services were more integrated than substance use. Future research should consider a revised version of the measure, a larger and more representative sample, and linking organizational capacity with patient outcomes. Copyright © 2012. Published by Elsevier Inc.

  4. Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges.

    Science.gov (United States)

    Memon, M A; Shmalberg, J; Adair, H S; Allweiler, S; Bryan, J N; Cantwell, S; Carr, E; Chrisman, C; Egger, C M; Greene, S; Haussler, K K; Hershey, B; Holyoak, G R; Johnson, M; Jeune, S Le; Looney, A; McConnico, R S; Medina, C; Morton, A J; Munsterman, A; Nie, G J; Park, N; Parsons-Doherty, M; Perdrizet, J A; Peyton, J L; Raditic, D; Ramirez, H P; Saik, J; Robertson, S; Sleeper, M; Dyke, J Van; Wakshlag, J

    2016-01-01

    Integrative veterinary medicine (IVM) describes the combination of complementary and alternative therapies with conventional care and is guided by the best available evidence. Veterinarians frequently encounter questions about complementary and alternative veterinary medicine (CAVM) in practice, and the general public has demonstrated increased interest in these areas for both human and animal health. Consequently, veterinary students should receive adequate exposure to the principles, theories, and current knowledge supporting or refuting such techniques. A proposed curriculum guideline would broadly introduce students to the objective evaluation of new veterinary treatments while increasing their preparation for responding to questions about IVM in clinical practice. Such a course should be evidence-based, unbiased, and unaffiliated with any particular CAVM advocacy or training group. All IVM courses require routine updating as new information becomes available. Controversies regarding IVM and CAVM must be addressed within the course and throughout the entire curriculum. Instructional honesty regarding the uncertainties in this emerging field is critical. Increased training of future veterinary professionals in IVM may produce an openness to new ideas that characterizes the scientific method and a willingness to pursue and incorporate evidence-based medicine in clinical practice with all therapies, including those presently regarded as integrative, complementary, or alternative.

  5. "It's All Connected!" Nursing Students' Experiences of a New Form of Case Seminar Integrating Medical and Nursing Science

    Science.gov (United States)

    Turunen Olsson, Pernilla; Weurlander, Maria; Mattiasson, Anne-Cathrine; Wärn Hede, Gunnel; Panagiotidis, Georgios; Broberger, Eva; Hult, Håkan; Wernerson, Annika

    2016-01-01

    Traditionally, nursing students learn medical subjects and nursing separately, which makes it difficult to develop an integrated understanding. This study aimed to explore nursing students' experiences of participating in a case seminar integrating medical and nursing sciences and if, and how, it contributed to their learning. A case seminar…

  6. Integrating natural language processing expertise with patient safety event review committees to improve the analysis of medication events.

    Science.gov (United States)

    Fong, Allan; Harriott, Nicole; Walters, Donna M; Foley, Hanan; Morrissey, Richard; Ratwani, Raj R

    2017-08-01

    Many healthcare providers have implemented patient safety event reporting systems to better understand and improve patient safety. Reviewing and analyzing these reports is often time consuming and resource intensive because of both the quantity of reports and length of free-text descriptions in the reports. Natural language processing (NLP) experts collaborated with clinical experts on a patient safety committee to assist in the identification and analysis of medication related patient safety events. Different NLP algorithmic approaches were developed to identify four types of medication related patient safety events and the models were compared. Well performing NLP models were generated to categorize medication related events into pharmacy delivery delays, dispensing errors, Pyxis discrepancies, and prescriber errors with receiver operating characteristic areas under the curve of 0.96, 0.87, 0.96, and 0.81 respectively. We also found that modeling the brief without the resolution text generally improved model performance. These models were integrated into a dashboard visualization to support the patient safety committee review process. We demonstrate the capabilities of various NLP models and the use of two text inclusion strategies at categorizing medication related patient safety events. The NLP models and visualization could be used to improve the efficiency of patient safety event data review and analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Integrative treatment approaches: family satisfaction with a multidisciplinary paediatric Abdominal Pain Clinic

    Directory of Open Access Journals (Sweden)

    Jennifer Verrill Schurman

    2010-08-01

    Full Text Available Objectives: To assess patient and family satisfaction with evaluation received through a multidisciplinary paediatric Abdominal Pain Clinic (APC staffed by a paediatric gastroenterologist and a paediatric psychologist as compared to a traditional gastroenterology clinic (GI staffed by a paediatric gastroenterologist only. Methods: Two hundred and ninety-eight families (145 APC, 153 GI with a child or adolescent aged 8-17 years seen for initial evaluation of a chronic abdominal pain completed an anonymous survey to assess understanding of the treatment recommendations made, intent to follow through with various treatment recommendations, and the overall level of satisfaction with the evaluation service provided. Family perceptions of strengths and challenges of the APC evaluation process also were explored. Results: APC families reported being prescribed adjunctive mental health and other therapies at significantly higher rates than GI families, while the rates of medication were comparable. APC families also reported significantly greater receptivity to beginning the treatments prescribed and higher levels of overall satisfaction with the evaluation process. The contribution of integrated medical and psychological perspectives frequently was identified as a strength of the APC evaluation process. Challenges identified for the APC evaluation were few and focused on issues related to paperwork and scheduling issues. Conclusions: Integrative care approaches to the evaluation of paediatric abdominal pain appear well accepted by families, yielding high levels of satisfaction, and enhance receptivity to treatment recommendations. Integrative care starting at the time of first evaluation may be particularly well-tailored to enhance outcomes, reduce health care utilization, and yield financial savings within this population.

  8. Medical Approach to Right Colon Diverticulitis with Perforation

    Directory of Open Access Journals (Sweden)

    James Espinosa

    2017-01-01

    Full Text Available We report a case of a 71-year-old female who presented with right lower quadrant (RLQ abdominal pain and was diagnosed on CT scan with right-sided diverticulitis with perforation. She was admitted under the surgical service after consultation and received intravenous fluids, intravenous antibiotics, and pain medications as needed. The patient was discharged 2 days after admission in stable condition with follow-up with gastroenterology. The differential diagnosis of right lower quadrant abdominal pain is vast. Right-sided diverticulitis often presents in a manner similar to appendicitis. In the absence of peritonitis, conservative treatment may be possible. It is predictable that as the population ages, the incidence of right-sided diverticular disease will increase and will result in more presentations of acute right-sided diverticulitis to the emergency department (ED. The aim of this case report is to increase awareness of the incidence, pathophysiology, presentation, work-up (laboratory studies and imaging, and management (medical and surgical of right-sided diverticulitis among emergency physicians.

  9. Learning environment, approaches to learning and learning preferences: medical students versus general education students.

    Science.gov (United States)

    Ullah, Raza

    2016-05-01

    The main objective of the study was to see whether medical students use more desirable approaches to studying than general education students. Survey method was used to collect data from both the medical students and the general education students. The survey of the medical students was carried out between January and March, 2012. The survey was administered to all the medical students present in lecture halls on day of data collection, while general education students were randomly selected from four subject areas at two universities. In total, 976 medical students and 912 general students participated in the study. Of the general students, 494(54%) were boys and 418(46%)were girls with an overall mean age of 20.53±1.77 years (range: 17-27 years). The medical students' perceptions of their learning environment and their learning preferences were broadly similar to that of general education students with the exception of workload. The medical students perceived the workload to be less appropriate (Mean = 2.06±0.72) than the students in general education (Mean = 2.84±0.90). The medical students were more likely to use the deep approach to studying (Mean = 3.66±0.59) than the students in general education (Mean = 3.16±0.91). The students in general education were slightly more likely to use the organized studying (Mean = 3.44±0.90) than the medical students (Mean =3.23±0.90). Both medical students and the students in general education tended to use the surface approaches along with other approaches to studying. There was not a great difference between the medical students and the students pursuing general education with regard to perceptions of the learning environment and approaches to learning.

  10. When science meets medical tradition: what is needed for a dialogue on integrative medicine?

    Science.gov (United States)

    Caspi, Opher; Baranovitch, Ofer

    2009-05-01

    It has been more than a decade since the release of the National Institutes of Health (NIH) and Food and Drug Administration (FDA) consensus statement declaring that acupuncture is not an experimental therapy but a sound medical technique comparable in effectiveness to common conventional medical treatments for certain clinical conditions, such as nausea and pain. For the first time in the history of modern medicine, a traditional medical system gained legitimacy in the Western medical establishment. Yet, it remains unclear whether the motivation behind this endorsement represents a unity of conceptualization regarding the desired structure of the health care system and the nature of the integration of conventional and complementary and alternative medicine (CAM). Two (2) doctors, each representing a different paradigm, met in order to discuss and elucidate issues that relate to the nature of the proposed integration between allopathy and CAM. Their responses to key questions prompted by the 1997 NIH/FDA consensus statement create a platform for a unified "contract" that represents their vision regarding the essence of collaboration between the two systems of medicine. Based on the richness of their discussion, it is recommended that other medical centers engage in similar dialogues in order to establish their own contracts. It is hoped that this will pave the way toward mutual acceptance, both conceptually and strategically, of a pluralistic health care system.

  11. Integrating consumer engagement in health and medical research - an Australian framework.

    Science.gov (United States)

    Miller, Caroline L; Mott, Kathy; Cousins, Michael; Miller, Stephanie; Johnson, Anne; Lawson, Tony; Wesselingh, Steve

    2017-02-10

    Quality practice of consumer engagement is still in its infancy in many sectors of medical research. The South Australian Health and Medical Research Institute (SAHMRI) identified, early in its development, the opportunity to integrate evidence-driven consumer and community engagement into its operations. SAHMRI partnered with Health Consumers Alliance and consumers in evidence generation. A Partnership Steering Committee of researchers and consumers was formed for the project. An iterative mixed-method qualitative process was used to generate a framework for consumer engagement. This process included a literature review followed by semi-structured interviews with experts in consumer engagement and lead medical researchers, group discussions and a consensus workshop with the Partnership Steering Committee, facilitated by Health Consumer Alliance. The literature revealed a dearth of evidence about effective consumer engagement methodologies. Four organisational dimensions are reported to contribute to success, namely governance, infrastructure, capacity and advocacy. Key themes identified through the stakeholder interviews included sustained leadership, tangible benefits, engagement strategies should be varied, resourcing, a moral dimension, and challenges. The consensus workshop produced a framework and tangible strategies. Comprehensive examples of consumer participation in health and medical research are limited. There are few documented studies of what techniques are effective. This evidence-driven framework, developed in collaboration with consumers, is being integrated in a health and medical research institute with diverse programs of research. This framework is offered as a contribution to the evidence base around meaningful consumer engagement and as a template for other research institutions to utilise.

  12. Integrating physical and financial approaches to manage environmental financial risk

    Science.gov (United States)

    Characklis, Gregory; Meyer, Eliot; Foster, Benjamin

    2017-04-01

    Physical and/or engineered solutions have long been used to manage risks associated with adverse environmental events. Examples include reservoirs as a tool for mitigating drought-related supply risk, levees for managing flood risk and dredging of inland waterways to ensure navigability during low flow periods. These measures can reduce many types of risk (e.g., loss of life), but are often employed as a means of protecting against financial losses. When the focus is on managing environmental financial risk, physical solutions can be effective, but also costly. In many cases, non-physical tools can provide a less expensive means of managing financial risk, with these often taking the form of financial instruments such as hedging contracts, contingency funds or insurance. Some of these instruments, such as flood insurance, are widely available, but historically many environmental financial risks have been managed primarily (or solely) via physical solutions without much consideration of alternatives, thereby opening opportunities for innovation in developing financial solutions. Recent research has demonstrated that financial instruments can play a significant role in managing drought-related financial risk in sectors as diverse as water utilities, energy generation and inland navigation. Nonetheless, this work has largely considered the use of these instruments within systems in which physical solutions are already in place (but failing to achieve desired performance). The next step in the evolution of managing environmental financial risk involves developing methods for designing risk management strategies that do not assume an established physical system. Here the goal is to identify the relative role that physical solutions and financial instruments should play as they are integrated into a comprehensive risk management strategy. This is not a straightforward challenge as one approach reduces the risk of financial losses and the other redistributes those losses

  13. Inviscid/Boundary-Layer Aeroheating Approach for Integrated Vehicle Design

    Science.gov (United States)

    Lee, Esther; Wurster, Kathryn E.

    2017-01-01

    A typical entry vehicle design depends on the synthesis of many essential subsystems, including thermal protection system (TPS), structures, payload, avionics, and propulsion, among others. The ability to incorporate aerothermodynamic considerations and TPS design into the early design phase is crucial, as both are closely coupled to the vehicle's aerodynamics, shape and mass. In the preliminary design stage, reasonably accurate results with rapid turn-representative entry envelope was explored. Initial results suggest that for Mach numbers ranging from 9-20, a few inviscid solutions could reasonably sup- port surface heating predictions at Mach numbers variation of +/-2, altitudes variation of +/-10 to 20 kft, and angle-of-attack variation of +/- 5. Agreement with Navier-Stokes solutions was generally found to be within 10-15% for Mach number and altitude, and 20% for angle of attack. A smaller angle-of-attack increment than the 5 deg around times for parametric studies and quickly evolving configurations are necessary to steer design decisions. This investigation considers the use of an unstructured 3D inviscid code in conjunction with an integral boundary-layer method; the former providing the flow field solution and the latter the surface heating. Sensitivity studies for Mach number, angle of attack, and altitude, examine the feasibility of using this approach to populate a representative entry flight envelope based on a limited set of inviscid solutions. Each inviscid solution is used to generate surface heating over the nearby trajectory space. A subset of a considered in this study is recommended. Results of the angle-of-attack sensitivity studies show that smaller increments may be needed for better heating predictions. The approach is well suited for application to conceptual multidisciplinary design and analysis studies where transient aeroheating environments are critical for vehicle TPS and thermal design. Concurrent prediction of aeroheating

  14. Mediterranean Storms: An Integrated Approach of Risk Management

    Science.gov (United States)

    Karageorgou, H.; Riza, E.; Linos, A.; Papanikolaou, D.

    2010-09-01

    Disaster by UN definition is "a serious disruption of the functioning of a community or a society, involving widespread human, material, economic, or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using only its own resources". Mediterranean storms induce flash floods caused by excessive amounts of rainfall within a short lasting period of time. The intensity and duration of precipitation, region geomorphology, urbanization and different governmental emergency management structures trigger different consequences between Mediterranean countries. The integrated approach in management of storm risk represents a holistic perspective including interactions between government, science and technology institutions, developing agencies, private sector, NGOs and public. Local authorities and national government are responsible for the design, preparation and decision on storm risk management policies and strategies considering scientific risk identifying, assessing and understanding. Efficient governance management requires satisfied response to early warning systems, functionality of the affected systems upon which society depends and appropriate focus on variable interest, beliefs, values and ideologies between social groups. Also an appropriate balancing of benefits and costs in an efficient and equitable manner is important for the governance risk management. Natural sciences in corporation with the engineering science have developed effective early prediction, warning and monitoring systems on storm and flood risk. The health sciences use prediction systems for health related hazards and consequences and the social sciences research estimates the human resilience during disasters and the factors which affect and determine the human behavior. Also social sciences survey the response of public to early warning messages, the appropriate communicative methods to distributing messages and mechanisms to improve public

  15. An approach to the neck mass | Thandar | Continuing Medical ...

    African Journals Online (AJOL)

    An approach to the neck mass. MA Thandar, NE Jonas. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

  16. A statistical approach to traditional Vietnamese medical diagnoses standardization

    International Nuclear Information System (INIS)

    Nguyen Hoang Phuong; Nguyen Quang Hoa; Le Dinh Long

    1990-12-01

    In this paper the first results of the statistical approach for Cold-Heat diagnosis standardization as a first work in the ''eight rules diagnoses'' standardization of Traditional Vietnamese Medicine are briefly described. Some conclusions and suggestions for further work are given. 3 refs, 2 tabs

  17. Approach to lower back pain | Moosajee | South African Medical ...

    African Journals Online (AJOL)

    Lower back pain is one of the most common symptoms – and the most common musculoskeletal problem – seen by general practitioners. It is also a common cause of disability and an expensive condition in terms of economic impact because of absenteeism. This article discusses an approach to this common symptom and ...

  18. A Mixed Learning Technology Approach for Continuing Medical Education

    Directory of Open Access Journals (Sweden)

    Vernon R. Curran

    2003-01-01

    Full Text Available Introduction: Distance learning technologies have been used for many years to provide CME to rural physicians. The purpose of this study was to evaluate the utility and acceptability of a mixed learning technology approach for providing distance CME. The approach combined audio teleconferencing instruction with a Web-based learning system enabling the live presentation and archiving of instructional material and media, asynchronous computer conferencing discussions, and access to supplemental online learning resources. Methodology: The study population was comprised of physicians and nurse practitioners who participated in audio teleconference sessions, but did not access the Web-based learning system (non-users; learners who participated in audio teleconferences and accessed the Web-based system (online users; and faculty. The evaluation focused upon faculty and learners’ experiences and perceptions of the mixed learning technology approach; the level of usage; and the effectiveness of the approach in fostering non-mandatory, computer-mediated discussions. Results and Discussion: The users of the Web-based learning system were satisfied with its features, ease of use, and the ability to access online CME instructional material. Learners who accessed the system reported a higher level of computer skill and comfort than those who did not, and the majority of these users accessed the system at times other than the live audio teleconference sessions. The greatest use of the system appeared to be for self-directed learning. The success of a mixed learning technology approach is dependent on Internet connectivity and computer access; learners and faculty having time to access and use the Web; comfort with computers; and faculty development in the area of Web-based teaching.

  19. The process-oriented approach to the increased efficiency of medical support

    Directory of Open Access Journals (Sweden)

    Bogma K.A.

    2017-03-01

    Full Text Available this article is intended to identify advantages of applying process-oriented approach to the increased efficiency of medical support quality management. To achieve this goal it is necessary to solve a number of tasks, consisting in the implementation analysis of definitions and identifying the specifics of medical support quality management contributed to confirming formulated hypothesis according to which administrative approach in quality management in the provision of medical services has less managerial potential than the process-oriented method, and it is more oriented to meet the needs of individuals in high-quality and affordable medical care. Theoretical and methodological basis is laid down by principles and aspects of activity and system approach as well as common management patterns acting as programmability of social actions applied in process-oriented approach. The author used methodology of the regulated influence of pursued policies and programs and such sociological methods of work as the collection, analysis, generalization, systematization of information.

  20. Biofilm eradication and prevention: a pharmaceutical approach to medical device infections

    National Research Council Canada - National Science Library

    Shunmugaperumal, Tamilvanan

    2010-01-01

    "Biofilm Eradication and Preventions presents the basics of biofilm formation on medical devices, diseases related to this formation, and approaches pharmaceutical researchers need to take to limit this problem...